Is Ab Interno Canaloplasty the Best Choice in Mild Glaucoma?

Canaloplasty performed via an ab interno approach significantly reduces intraocular pressure (IOP) and medication burden safely in patients with primary and secondary open-angle glaucoma, according to data from the iTrack Global Data Registry (iTGDR) of glaucoma surgery and one of its founders, Keith Barton MD.

The iTGDR is a prospective, multicentre study established to collect comprehensive real-world clinical outcomes on the efficacy and safety of canaloplasty using the iTrack and iTrack Advance microcatheter devices for treating glaucoma. The cloud-based data set collects surgeon data across approximately 20 sites in the United States, Canada, Europe, Asia, and Australia.

“The whole aim of the registry was to provide a bigger prospective picture of the glaucoma landscape, as there are so many procedures,” Dr Barton explained. “A lot of them are doing the same thing in slightly different ways, making it much more difficult to get a perspective on what is working better. So we hoped, by having large data on many procedures, we would get a feel for what the reality is.”

Real-world data

Dr Barton presented real-world outcome data on eyes with primary or secondary open-angle glaucoma that underwent ab interno canaloplasty using the iTrack or iTrack Advance in combination with phacoemulsification and had at least 12 months of follow-up. This study involved 334 eyes of 250 patients up to November 2025.

Outcomes were assessed at baseline and at the last available follow-up. Success was defined using American Academy of Ophthalmology criteria.

Mean baseline IOP and medication use were 17.0±5.1 mmHg and 2.05±1.1, respectively, and were significantly reduced to 14.1±3.8 mmHg and 1.2±1.4 medications (P < 0.001) at the last available follow-up (mean 20.2±7.8 months).

Medication-free eyes increased from 6.6% (n=22) at baseline to 42.5% (n=142) postoperatively, Dr Barton reported. Success was achieved in 62.0% of eyes (n=207) postoperatively.

Intraoperative complications occurred in 0.3% of cases (n=1), postoperative complications in 2.7% of cases (n=9), and 4.2% of eyes (n=14) required additional glaucoma surgery.

Strong evidence base

The data shows the iTGDR provides valuable real-world evidence on the clinical effectiveness of canaloplasty in mild glaucoma and confirms why it makes sense to choose this minimally invasive option where possible, he commented.

“There isn’t much evidence that any of the canal procedures are better than any other,” he told EuroTimes. “So, what you want to do is the least invasive procedure first, which is canaloplasty. You are not leaving a device behind, you are not tearing the mesh or stripping it or anything. It does make a lot of sense to use it in mild glaucoma, especially in cataract surgery as the complication rate is very low.”

The registry continues to collect data to further strengthen its findings and should be viewed by all glaucoma surgeons to support evidence-based decision making, Dr Barton said.

Dr Barton presented the iTGDR data at the Irish College of Ophthalmologists 2026 annual conference in Galway.

Keith Barton MD, FRCP, FRCS, FRCOphth is a consultant ophthalmic surgeon at Moorfields Eye Hospital, London, UK, and Professor of Ophthalmology, University College London. keith@keithbarton.co.uk