Canaloplasty ab interno (AbiC) – 2-Year-Results of a Novel Minimally Invasive Glaucoma Surgery (MIGS) Technique

Abstract

Purpose The aim of this study is to evaluate the long-term efficacy of a novel minimally invasive glaucoma surgery technique (MIGS), Ab interno Canaloplasty (AbiC).

Material and Methods For this retrospective cohort study, we analysed the data of 25 eyes of 23 patients with open angle glaucoma who underwent an AbiC (6 eyes) or in case of an additional cataract, a combined cataract-AbiC procedure (“phacocanaloplasty ab interno”, 19 eyes), respectively. Postoperatively, we investigated the intraocular pressure (IOP) and the number of still required IOP-lowering medication, as well as surgery-related complications.

Results Overall, the mean baseline IOP of 20.24 mmHg ± 5.92 (n = 25) was reduced to 10.64 mmHg ± 2.77 (n = 25, p < 0.001), 12.55 mmHg ± 3.33 (n = 22, p < 0.001) and 13.67 mmHg ± 2.15 (n = 21, p < 0.001) at 1 day, 1 year and 2 year follow-up visit, respectively. Compared to baseline, this implies a reduction in IOP of 47.4, 37.9 and 32.5%. An average glaucoma medication usage of 1.92 ± 1.04 was registered at baseline visit and was reduced to 0,05 ± 0,23 after 2 years of follow-up. 80% of patients were off medication. In 5 eyes (20%) further antiglaucomatous eye drops or surgical treatment were administered. The only surgical complications were hyphema in 5 eyes (20%) and a localized peripheral detachment of the Descemetʼs membrane in one eye (4%) with no late sequelae.

Conclusion AbiC performed independently or combined with cataract surgery seems to be a safe and effective MIGS-technique with good long-term regulation of IOP and low risk profile.

Key words

MIGS - canaloplasty ab interno - canaloplasty - iTrack

Publication History

Received: 27 June 2020

Accepted: 31 August 2020

Article published online:
17 November 2020

• References/Literatur

• 1 Lewis RA, von Wolff K, Tetz M. et al. Canaloplasty: circumferential viscodilation and tensioning of Schlemmʼs canal using a flexible microcatheter for the treatment of open-angle glaucoma in adults: interim clinical study analysis. J Cataract Refract Surg 2007; 33: 1217-1226 doi:10.1016/j.jcrs.2007.03.051
• 2 Khaimi MA. Canaloplasty: A Minimally Invasive and Maximally Effective Glaucoma Treatment. J Ophthalmol 2015; 2015: 485065 doi:10.1155/2015/485065
• 3 Körber N. [Canaloplasty ab interno – a Minimally Invasive Alternative]. Klin Monbl Augenheilkd 2017; 234: 991-995 doi:10.1055/s-0042-123829
• 4 Saheb H, Ahmed II. Micro-invasive glaucoma surgery: current perspectives and future directions. Curr Opin Ophthalmol 2012; 23: 96-104 doi:10.1097/ICU.0b013e32834ff1e7
• 5 Körber N. Ab interno canaloplasty for the treatment of glaucoma: a case series study. Spektrum Augenheilkd 2018; 32: 223-227 doi:10.1007/s00717-018-0416-7
• 6 Lewis RA, von Wolff K, Tetz M. et al. Canaloplasty: Three-year results of circumferential viscodilation and tensioning of Schlemm canal using a microcatheter to treat open-angle glaucoma. J Cataract Refract Surg 2011; 37: 682-690 doi:10.1016/j.jcrs.2010.10.055
• 7 Gallardo MJ, Supnet RA, Ahmed IIK. Viscodilation of Schlemmʼs canal for the reduction of IOP via an ab-interno approach. Clin Ophthalmol 2018; 12: 2149-2155 doi:10.2147/OPTH.S177597
• 8 Davids AM, Pahlitzsch M, Boeker A. et al. Ab interno canaloplasty (ABiC)-12-month results of a new minimally invasive glaucoma surgery (MIGS). Graefes Arch Clin Exp Ophthalmol 2019; 257: 1947-1953 doi:10.1007/s00417-019-04366-3
• 9 Ondrejka S, Körber N. 360° ab-interno Schlemmʼs canal viscodilation in primary open-angle glaucoma. Clin Ophthalmol 2019; 13: 1235-1246 doi:10.2147/OPTH.S203917
• 10 Craven ER, Katz LJ, Wells JM. et al. Cataract surgery with trabecular micro-bypass stent implantation in patients with mild-to-moderate open-angle glaucoma and cataract: two-year follow-up. J Cataract Refract Surg 2012; 38: 1339-1345 doi:10.1016/j.jcrs.2012.03.025
• 11 Esfandiari H, Taubenslag K, Shah P. et al. Two-year data comparison of ab interno trabeculectomy and trabecular bypass stenting using exact matching. J Cataract Refract Surg 2019; 45: 608-614 doi:10.1016/j.jcrs.2018.12.011
• 12 Wakil SM, Birnbaum F, Vu DM. et al. Efficacy and Safety of Kahook Dual Blade Goniotomy: 18-Month Results. J Cataract Refract Surg 2020;
• 13 Brusini P. Canaloplasty in open-angle glaucoma surgery: a four-year follow-up. ScientificWorldJournal 2014; 2014: 469609 doi:10.1155/2014/469609
• 14 Brusini P, Caramello G, Benedetti S. et al. Canaloplasty in Open-angle Glaucoma: Mid-term Results From a Multicenter Study. J Glaucoma 2016; 25: 403-407 doi:10.1097/IJG.0000000000000103
• 15 Khaimi MA, Dvorak JD, Ding K. An Analysis of 3-Year Outcomes Following Canaloplasty for the Treatment of Open-Angle Glaucoma. J Ophthalmol 2017; 2017: 2904272 doi:10.1155/2017/2904272
• 16 Grieshaber MC, Schoetzau A, Flammer J. et al. Postoperative microhyphema as a positive prognostic indicator in canaloplasty. Acta Ophthalmol 2013; 91: 151-156 doi:10.1111/j.1755-3768.2011.02293.x
• 17 Grieshaber MC, Pienaar A, Olivier J. et al. Clinical evaluation of the aqueous outflow system in primary open-angle glaucoma for canaloplasty. Invest Ophthalmol Vis Sci 2010; 51: 1498-1504 doi:10.1167/iovs.09-4327