Canaloplasty

Abstract

Canaloplasty is a non-penetrating glaucoma procedure that adopts an ab externo approach to improve aqueous outflow through the conventional pathway. Using a microcatheter with fiber-optic light guidance, a nonabsorbable suture is passed throughout the entire Schlemm's canal and is tightened to put the trabecular meshwork on stretch, thereby maintaining canal patency and enhancing outflow. Potential complications are similar to those encountered in traditional penetrating procedures such as trabeculectomy, but given that no patent ostium or iridectomy is required, canaloplasty has lower risks of potentially devastating complications such as hypotony, choroidal effusion, or suprachoroidal hemorrhage. Studies have shown the efficacy of canaloplasty to be better than modest; thus, patients with mild to moderate open-angle glaucoma who require mid-teens target IOP are suitable candidates. Though a technically demanding procedure, canaloplasty's excellent safety profile makes it a valuable surgical alternative in patients where early surgery is favorable and/or in high-risk cases.