Search

Purpose To assess the safety and efficacy of circumferential viscocanalostomy (canaloplasty) using a new canal expander in Caucasians with primary open-angle glaucoma (POAG). Methods Thirty-five eyes of 35 consecutive patients with medically uncontrolled POAG underwent primary canaloplasty and implantation of the Stegmann Canal Expander into Schlemm's canal. Schlemm's canal was unroofed ab externo, and dilated with viscoelastic material and microcatheter. The Stegmann Canal Expander was implanted into the canal lumen, and the superficial scleral flap was closed watertight. Laser goniopuncture of the trabeculo-Descemet's membrane window was performed if postoperative intraocular pressure (IOP) exceeded 16 mmHg. Results The mean IOP dropped from 26.6 ± 4.2 mm Hg preoperatively to 12.1 ± 2.6 mm Hg at 1 month, 13.1 ± 1.9 mmHg at 6 months, 13.0 ± 1.9 mm Hg at 12 months, and 13.4 ± 2.4 mm Hg at 24 months (p < 0.001). Laser goniopuncture was performed on 5 eyes (14.7%) 6.4 months after surgery; the mean IOP was 19.1 mm Hg before and 14.1 mm Hg after goniopuncture. The number of medications dropped from 2.9 ± 0.3 before surgery to 0.08 ± 0.3 after surgery (p < 0.001). The postoperative BCVA at last visit (0.12 ± 0.09; range, 0-0.39) was comparable to preoperative values (0.16 ± SD 0.10; range, 0-0.39) (p = 0.35). Complications were minor and included microhyphema (14 eyes) and transient elevated IOP (steroid responder; 4 eyes), partial peripheral Descemet's membrane detachment (2 eyes). Conclusions Canaloplasty with implantation of the Stegmann Canal Expander reduced IOP significantly in POAG with a low risk for complications. [ABSTRACT FROM AUTHOR]

Purpose: To compare a modified incision technique with classic scleral flap dissection for canaloplasty with canal expander regarding efficacy and safety., Methods: In a prospective randomized pilot study of 32 eyes of 16 patients with primary open-angle glaucoma, access to Schlemm's canal was created by deep lamellar dissection (scleral flap excision, group 1) or by vertical cut-down incision (group 2). Following canal opening and viscodilation with microcannula and sodium hyaluronate, two Stegmann Canal Expanders were implanted, and the scleral flap or vertical incision, respectively, was closed watertight., Results: Mean preoperative intraocular pressure (IOP) was 34.9 mmHg ± 6.7 [standard deviation (SD)] in group 1 and 33.8 mmHg ± 7.7 (SD) in group 2 (p = 0.66); mean postoperative IOP without medications was 14.3 mmHg ± 2.9 (SD) in group 1 and 14.8 mmHg ± 5.2 (SD) in group 2 at 1 month (p = 0.76), and 14.4 mmHg ± 1.9 (SD) in group 1 and 16.8 mmHg ± 3.1 (SD) in group 2 at 12 months (p = 0.01). Overall, there was a significant preoperative-postoperative IOP difference between groups (19.4 mmHg ± 10.1, group 1; 16.6 mmHg ± 8.9, group 2; p = 0.02). Surgery type had a significant effect when adjusted for preoperative IOP, cup-disc ratio, eye side, follow-up number and surgery type (p < 0.01, anova). No filtering bleb was observed in either group. Intra- and postoperative complications were rare and included peripheral Descemet's membrane detachment (3), microhyphema (2) and cannulation into the anterior chamber (1)., Conclusions: In this intra-individual comparative study of ab externo canaloplasty with the canal expander, IOP reduction was substantial in both groups and slightly greater in the group with deep scleral flap excision. Additional IOP reduction by transscleral drainage through the Descemet's membrane window and intrascleral lake is suggested., (© 2019 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To examine longer-term postsurgical safety and efficacy of a new expander for Schlemm's canal., Methods: In a non-comparative, prospective study, 42 White patients with medically uncontrolled primary open-angle glaucoma (POAG) underwent primary canaloplasty with >2-year follow-up. The bleb-independent procedure comprised catheter-assisted canaloplasty and implantation of two Stegmann Canal Expanders to maintain trabecular distension and canal patency over 180°. Intraocular pressure (IOP), glaucoma medication use and complications were assessed., Results: Mean IOP was 26.8 ± 5.6 mmHg presurgery, 12.8 ± 1.5 mmHg at 6 months, 13.2 ± 1.2 mmHg at 12 months and 13.3 ± 2.5 mmHg at 24 months (p < 0.001). Rate of complete success, defined as IOP ≤21, ≤18 and ≤16 mmHg and a ≥ 30% IOP reduction, was 85% (95% CI: 0.76-0.95), 85% (0.76-0.95) and 82% (0.70-0.96) at 12 months and 83% (0.73-0.94), 80% (0.70-0.92) and 80% (0.70-0.92) at 24 months. Preoperative factors were not significant predictors of ≤16 mmHg IOP reduction: IOP (hazard ratio [HR]: 0.68; 95% CI: 0.44-1.04; p = 0.08), mean visual defect (1.06; 0.90-1.20; p = 0.47), number of medications (0.59; 0.17-2.14; p = 0.42) and age (0.96; 0.87-1.13; p = 0.41). Number of medications dropped from 2.8 ± 0.4 presurgery to 0.2 ± 0.5 postsurgery (p < 0.001). Mean preoperative best-corrected visual acuity was 0.19 ± SD 0.21 (range: 0-1.6), and logMAR was similar to 0.23 ± 0.16 (range: 0-1.6; p = 0.42) after a mean follow-up of 27.4 months. Complications included peripheral Descemet's membrane detachment (7.2%) and trimming of the expander (4.7%) during surgery, and transient microhyphaema (23.8%) and IOP elevation (7.2%) postsurgery., Conclusion: Canaloplasty with the Stegmann Canal Expander was a safe and effective procedure to reduce IOP in White patients with moderate to advanced POAG., (© 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To study the safety and long-term efficacy of classic viscocanalostomy in patients with open-angle glaucoma (OAG) in different populations., Methods: A total of 726 eyes of 726 patients from Europe or South Africa with primary OAG (POAG) and pseudoexfoliative glaucoma (PXFG) were included in this retrospective multicentre study. Complete (qualified) success was defined as an intraocular pressure (IOP) equal to or lower than 21, 18 and 16 mmHg without (with or without) medications, respectively. A failed procedure was defined if IOP was above 21 mmHg, not controllable by laser goniopuncture or medications., Results: The mean IOP before surgery was 42.6 ± 14.2 mmHg for all patients, 29.6 ± 6.6 mmHg for European patients and 48.1 ± 12.9 mmHg for African patients. The follow-up time was 86.2 ± 43.1 months. Mean IOP was 15.4 ± 3.6 mmHg at 5 years, 15.5 ± 4.4 mmHg at 10 years and 16.8 ± 4.2 mmHg at 15 years. The qualified success rate for an IOP of 21, 18 or 16 mmHg or less after 5 years was 92% [95% confidence interval (CI) 0.88-0.96], 70% (95% CI 0.63-0.77) and 43% (95% CI 0.36-0.51) in European patients, and 90% (95% CI 0.87-0.93), 77% (95% CI 0.74-0.81) and 67% (95% CI 0.63-0.72) in African patients, respectively. There was no difference between the success rate for POAG and PXFG for an IOP of 21, 18 or 16 mmHg or less at 5 years (p = 0.64, p = 0.20, p = 0.22, respectively). Laser goniopuncture was performed postoperatively on a total of 127 eyes (17.7%), lowering the pressure from 23.1 ± 1.9 mmHg to 15.0 ± 2.2 mmHg. There were no significant complications, in particular, no blebitis or endophthalmitis., Conclusion: Viscocanalostomy produced a sustained long-term reduction of IOP with a low-risk profile in European and African patients with OAG over 12 years., (© 2014 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)