Is Canaloplasty That Perfect Procedure For Every Glaucoma Patient? – Evaluation Of Its Efficacy And Safety In The Treatment Of Primary And Secondary Open Angle Glaucoma Over 5 -Years Follow Up Period.

Open-angle glaucoma (OAG), constituting 90% of glaucoma cases, is a progressing optic nerve neuropathy that frequently results in irreversible visual field loss and eventually blindness. Surgical intervention becomes a consideration when conservative treatment options prove inefficient in stopping OAG progression. A few years ago canaloplasty, a new alternative to conventional trabeculectomy, was introduced for invasive OAG treatment. The aim of our study was to investigate safety and efficacy of canaloplasty in the treatment of four different types of Glaucoma: Primary Open Angle Glaucoma (POAG), Pigmentary Glaucoma (PG), Pseudoexfoliative Glaucoma (PXG) and Uveitic Glaucoma (UG)

This prospective study evaluated 80 eyes of 80 patients with medically uncontrolled glaucoma that received full 360° canaloplasty with placement of a tensioning suture. Primary OAG (n = 35), secondary OAG in pseudoexfoliative syndrome (n = 13), pigmentary glaucoma (n = 19) and uveitic glaucoma (n=13) patients were included. The mean follow-up period was 37,46±17,38 months (ranged from 9 to 60 months).

 Primary endpoints included surgical success, the mean reduction in IOP values and in number of glaucoma medication after the intervention and postsurgical complications. Secondary endpoints included visual acuity, surgically induced astigmatism (SIA) and laser flare photometry measurement

The pre-operative mean intraocular pressure (IOP) was 21,84 mmHg ±4,16 (range 17–35) with the mean of 3,12±0,88 (range 1-4) medications. After 1, 2, 3, 4 and 5 years from intervention, the mean IOP was 13,52±3,43, 14±2,76, 14,02±2,8, 13,57±2,46 and 13±1,89 mmHg, respectively, with 0,22±0,62, 0,29±0,55, 0,54±0,91, 0,58±0,99 and 0,42±0,79  medications  In the UG group eyes had a mean IOP of 14,44±3,54mmHg on 0.2±0.63 medications at 18 months as compared with preoperative levels of 40,53±9,34mm Hg on 3,6±0,63 (P= 0,0006). At 5 years postoperative, 68% eyes did not require any glaucoma medications. The incidence of complications after canaloplasty was low, and none of the adverse effects were vision threatening. 

Canaloplasty resulted in a notable decrease in intraocular pressure (IOP) across all four types of open-angle glaucoma (OAG) and a reduced reliance on antiglaucoma medication. However, pigmentary glaucoma and uveitic glaucoma patients were the most beneficial subgroups, with the highest success rate. In summary, canaloplasty has shown itself to be a safe and effective procedure for the treatment of various types of open-angle glaucoma (OAG).