Long-term effect of canaloplasty on intraocular pressure and use of intraocular pressure–lowering medications in patients with open-angle glaucoma. Issue 12 (1st December 2022)

• Record Type: Journal Article
• Authors: Ondrejka, Simon; Körber, Norbert; Dhamdhere, Kavita
• Is Part Of: Journal of cataract and refractive surgery. Volume 48:Issue 12(2022)
• Page Start: 1388
• Page End: 1393
• Publication Date: 2022-12-01
• Subjects: 617.7
• DOI: 10.1097/j.jcrs.0000000000001000
• Languages: English
• ISSNs: 0886-3350

Abstract

Abstract : An ongoing retrospective study found that canaloplasty performed alone or with cataract extraction in patients with OAG resulted in consistently reduced IOP and use of IOP-lowering medications up to 42 months postoperatively. Abstract : Purpose: To assess the long-term safety and effectiveness of canaloplasty in reducing intraocular pressure (IOP) and use of IOP-lowering medications in eyes with open-angle glaucoma (OAG). Setting: Surgical center (Augencentrum Köln, Köln, Germany). Design: Retrospective study. Methods: 206 eyes from 130 patients were included. Canaloplasty was performed using the VISCO360 or OMNI surgical system as a stand-alone procedure in 22 eyes and concomitantly with cataract extraction (CE) in 185 eyes with chronic OAG insufficiently controlled or intolerant to IOP-lowering medications. The number of hypotensive medications and IOP were recorded at baseline, day 1, week 1, month 1, month 3, and every 3 months thereafter, with the last follow-up visit at 36 ± 6 months postoperatively. Patients were stratified by baseline IOP (Group 1, IOP >18 mm Hg; Group 2, IOP ≤18 mm Hg). Treatment success in Group 1 was defined as a reduction in IOP and the use of IOP-lowering medications; Group 2 success was defined as maintenance of a lower IOP and a reduction in medication use. Results: The preoperative mean IOP of both groups was 21.1 ± 8.8 mm Hg, with a mean of 2.0 ± 0.9 hypotensive medications. The primary success end point was met by 73% of patients, with a mean IOP reduction in Group 1 (131 eyes; 21.8 to 15.6 mm Hg, P < .0001) and a maintenance of IOP control in Group 2 (76 eyes; 15.4 to 13.9 mm Hg, P = .24). Medications decreased from 2.2 ± 0.9 to 0.9 ± 1.1 in Group 1 ( P = .024) and from 1.8 ± 0.8 to 0.7 ± 1.0 in Group 2 ( P = .003). Conclusions: Canaloplasty alone or in conjunction with CE with the VISCO360 or OMNI surgical system is a safe, tissue-sparing, and effective minimally invasive glaucoma surgery, using a clear corneal incision in phakic or pseudophakic eyes. Canaloplasty performed with both evaluated devices achieved statistically significant, consistent, and clinically meaningful reductions in IOP and use of IOP-lowering medications in adult patients with OAG. In the consistent cohort (n = 42), the IOP-lowering effect lasted up to 42 months, with ongoing data collection expected to describe long-term effectiveness of this intervention.