Canaloplasty glaucoma surgery reduces IOP by restoring the trabeculocanalicular outflow pathway.
What is Canaloplasty?
Canaloplasty is circumferential dilation and stenting of Schlemm’s canal with a viscoelastic agent and a Prolene suture. Schlemm’s canal is the drainage channel into which intraocular fluid drains after passing through the pores of the trabecular meshwork. It is a circular microscopic canal that lies within the tissues at the junction of the cornea and the sclera.
Recent advances in technology have enabled the development of a 250 micron flexible microcatheter with an illuminated tip (iTrack™, iScience Interventional, Menlo Park, CA) that passes through Schlemm’s canal. The availability of this microcatheter along with advances in ocular ultrasound and viscoelastics have lead to the development of Canaloplasty, as a promising non-penetrating surgical technique for lowering intraocular pressure in patients with open angle glaucoma.
Who is a good candidate for Canaloplasty?
Canaloplasty is indicated for the surgical treatment of open angle glaucomas. It is contraindicated in patients with angle recession, neovascular glaucoma, chronic angle closure, narrow angle glaucoma, narrow inlets with plateau iris and in patients with previous surgery which would prevent 360 degree cathetereization of Schlemm’s canal.
How does it work?
Canaloplasty reduces IOP by restoring the trabeculocanalicular outflow pathway. It increases the flow of aqueous humor from the anterior chamber, through the trabecular meshwork and Descemet’s window, into and around Schlemm’s canal, and out through the collector channels. The hypothesis is the suture tensioning acts similar to pilocarpine increasing trabecular meshwork permeability. This procedure does not create a ‘bleb’ on the surface of the eye as fluid is routed through normal physiological pathways.
What is involved with a Canaloplasty procedure?
When you and your doctor make a decision to proceed with Canaloplasty you will meet with our preoperative scheduling nurse who will give you detailed instructions on how to prepare yourself for your up coming surgery and what is involved in getting to the operative room for the procedure. See Preoperative instructions for more information.
This is an outpatient procedure performed in an ambulatory surgery center. The surgery itself takes less than one hour in most cases. The surgery is usually done under local anesthesia with intravenous sedation. After surgery, the eye generally is covered by an eye patch and protected by a plastic shield overnight. On the morning following the surgery, it is removed and the eye is examined by your ophthalmologist. Eye drops are then prescribed to prevent infection, and reduce inflammation. For more details click on Postoperative instructions.
For several weeks following the surgery, your ophthalmologist will observe your eye closely and examine you frequently. During your postoperative visits your doctor may perform a high resolution ultrasound examination of your eye to visualize Schlemm’s canal and to assess the extent of its dilation. It may take up to 12 weeks after your surgery for the healing to be complete. During this time it is not unusual for your intraocular pressure, as well as vision to fluctuate.