[Circumferential viscocanalostomy with suture tensioning in Schlemm canal (canaloplasty)-one year experience]

Descemet's Membrane Detachment during Phacocanaloplasty: Case Series and In-Depth Literature Review

This article presents three cases of Descemet's membrane detachment (DMD) occurring during 'ab externo' phacocanaloplasty procedures in three patients with uncontrolled primary open-angle glaucoma (OAG) and discusses the management of this condition by reviewing the available literature. Following a successful 360° cannulation of Schlemm's canal (SC), the microcatheter was withdrawn while an ophthalmic viscosurgical device (OVD) was injected into the canal. During passage through the inferonasal quadrant, a spontaneous separation of the posterior layer of the cornea was observed. Each case was managed differently after diagnosis, with the third case being drained intraoperatively based on experience gained from the previous cases. On the first postoperative day, slit-lamp biomicroscopy (BMC) revealed multiple DMDs in case one and a hyphema in the lower third of a deep anterior chamber. In the other two cases, a single DMD was observed. The second case developed hemorrhagic Descemet membrane detachment (HDMD), while the other two were non-hemorrhagic. In all three cases, anterior segment optical coherence tomography (AS-OCT) revealed the presence of retrocorneal hyperreflective membranes indicative of DMDs. These membranes were located in the periphery of the cornea and did not impact the visual axis. After evaluation, a small incision was made in the inferotemporal DMD of the first case. However, for the two remaining cases, a strategy of watchful waiting was deemed appropriate due to the location and size of the DMDs, as they did not affect the best-corrected visual acuity (BCVA). Over time, the patients demonstrated progressive improvement with a gradual reduction in the size of the DMDs.

Efficacy and safety of non-penetrating glaucoma surgery with phacoemulsification versus non-penetrating glaucoma surgery: a Meta-analysis

AIM

To compare the clinical efficacy and safety of non-penetrating glaucoma surgery (NPGS) plus phacoemulsification (Phaco-NPGS) and NPGS-alone.

METHODS

We systematically searched various databases and reviewed studies that had evaluated the effects of Phaco-NPGS or NPGS-alone for patients with glaucoma. Primary outcomes included postoperative intraocular pressure (IOP) and the number of postoperative antiglaucoma medications. Secondary outcomes were the prevalence of complications, incidence of needling or goniopuncture, and surgical success rate.

RESULTS

In total, 380 and 424 eyes in NPGS-alone and Phaco-NPGS groups respectively were included. Both postoperative IOP and number of medications were significantly lowered in the Phaco-NPGS group than that in the NPDS-alone group [weighted mean difference (WMD)=-1.12, 95% confidence interval (CI): -2.11 to -0.12, P=0.03; WMD=-0.31, 95%CI: -0.53 to -0.09, P=0.006]. Moreover, Phaco-NPGS had a significantly lower prevalence of complications and postoperative procedures compared to NPGS-alone, while no significant difference existed for surgical success.

CONCLUSION

Phaco-NPGS superior to NPGS-alone in the reduction of IOP and medications. Phaco-NPGS can be recommended for glaucoma patients with coexisting cataracts owing to its superior efficacy, fewer complications, and postoperative procedures.

Ab interno canaloplasty for the treatment of glaucoma: a case series study

Purpose

To describe and evaluate the efficacy of ab interno canaloplasty (ABiC) in patients with primary open-angle glaucoma (POAG).

Methods

This single-center consecutive case series study included patients with cataract and open-angle glaucoma (combined procedure) and pseudophakic patients (mean age, 76 years; range, 66–83 years) with POAG who underwent ABiC using the iTrack™ 250-μm microcatheter (Ellex Medical Lasers Pty Ltd, Adelaide, Australia) to circumferentially viscodilate and intubate Schlemm’s canal without placement of a tensioning suture. The primary endpoints were mean intraocular pressure (IOP) and mean number of glaucoma medications at 1, 3, 6, 9, and 12 months postoperatively.

Results

In total, 20 patients (20 eyes) were enrolled in the study. Mean IOP reduced from 18.5 ± 3.44 mm Hg preoperatively to 14.88 ± 2.82 mm Hg (n = 17), 13.80 ± 2.05 (n = 12), 14.57 ± 2.59 mm Hg (n = 9) and 15.47 ± 2.42 (n = 6) at 1, 3, 6 and 9 months postoperatively. The 12‑month data for two patients showed that IOP had reduced from 17 mm Hg preoperatively to 16 mm Hg in one patient and from 20 mm Hg to 13 mm Hg in the other patient. The mean number of medications was reduced from 2.4 preoperatively to 0.25 at the last follow-up visit. There was one reported complication of limited descemetolysis near the limbus by the viscoelastic during the dilatation of Schlemm’s canal. No adverse events as a result of the device were reported.

Conclusions

ABiC was straightforward to perform in this group of patients with minimal complications. Although initial findings from this study indicate that ABiC is comparable to conventional canaloplasty in lowering IOP and medication dependency, long-term follow-up in a large patient cohort is required to confirm the efficacy of this minimally invasive glaucoma procedure.

A System Review and Meta-Analysis of Canaloplasty Outcomes in Glaucoma Treatment in Comparison with Trabeculectomy

Purpose. This system review studied the efficiency and safety of canaloplasty (CP) and compared the outcomes between CP and trabeculectomy (TE). Methods. Literatures were searched in PubMed and EMBASE. The meta-analysis was conducted on the postoperative outcomes in CP and then on the differences of outcomes between CP and TE. Results. In the meta-analysis, IOP decreased by 9.94 (95% CI 8.42 to 11.45) mmHg with an average AGM reduction of 2.11 (95% CI 1.80 to 2.42) one year after CP. The IOP reduction was significantly higher after TE than after CP, with an average difference of 3.61 (95% CI 1.69 to 5.53) mmHg at 12 months postoperationally. For complications, the incidence of hyphema was significantly higher in CP and the Descemet membrane detachment was just reported in CP, with an incidence of 3%. However, the incidence was significantly lower in CP of hypotony and of choroidal effusion/detachment. Meanwhile, suprachoroidal hemorrhage and bleb needling were only reported in TE. Conclusions. CP was less effective in IOP reduction than TE, but CP was able to achieve similar postoperative success rates and reduce the number of AGMs likewise. CP was also associated with lower incidence of complications. More high-quality researches are needed in the future to verify our findings in this system review.

Comparison of canaloplasty and trabeculectomy for open angle glaucoma: a Meta-analysis

AIM

To evaluate the advantage of canaloplasty compared to trabeculectomy for patients with open angle glaucoma.

METHODS

Potentially relevant studies were systematically searched using various databases from inception until December 2015. The outcome analyses performed automatically using Revman 5.3 included intraocular pressure reduction (IOPR), postoperative success rate, anti-glaucoma medications reduction and the incidence of adverse events.

RESULTS

We included four qualified studies incorporating a total of 215 eyes for quantitative synthesis. The weighted mean difference (WMD) of IOPR between canaloplasty and trabeculectomy from baseline to 12mo was -2.33 (95%CI: -4.00, -0.66). There was not significant improvement in the complete or qualified success rate (OR: 0.58, 95%CI: 0.26, 1.31; OR: 0.50, 95%CI: 0.10, 2.44, respectively). Similarly, no statistically significance was observed in anti-glaucoma mediations reduction (WMD: -0.54, 95%CI: -1.18, 0.09). Sensitivity analysis of the primary outcome estimate confirmed the stability of the Meta-analysis result.

CONCLUSION

Trabeculectomy seems to be more effective in lowering IOP up to 12mo when comparing with canaloplasty. Canaloplasty does not seem to be inferior to trabeculectomy considering the postoperative success rate or the number of postoperative anti-glaucoma medications. Meanwhile, it has an advantage of less bleb related complications.