Canaloplasty is an advanced non-penetrating, non-destructive procedure to treat Open Angle Glaucoma. It can help many patients with glaucoma to reduce their intraocular pressure, dependence on medications with fewer complications and also fewer follow-up in comparing to other traditional procedures.
In this procedure a microcatheter with a diameter of 200 microns is used to enlarge the natural drainage system of the aqueous humor in the patient eye, which is called Canal of Schlemm.
Indications of Canaloplasty
1- Open Angle Glaucoma patients.
2- Eye drops for Glaucoma are inconvenient, difficult, or costly for the patients.
3- Anti-Glaucoma medications are not working any more in reduction of Intraocular Pressure.
4- Patient is scheduled for more invasive glaucoma surgery.
5- Patients who are bad candidate for standard glaucoma surgery, Trabeculectomy such as patients who had failed Trabeculectomy in the other eyes, who wear contact lenses, with high risk of infection or bleeding.
Contraindications of the Procedure
1- Narrow-Angle Glaucoma.
2- Glaucoma due to high Episcleral Venous Pressure.
3- Neovascular glaucoma.
Advantages of Canaloplasty
What are the Advantages of Canaloplasty
1- Non-penetrating, non destructive of eye’s natural drainage system.
2- Well-controlled intraocular pressure.
3- Reduce dependence on expensive Anti-glaucoma medications.
4- Less invasive procedure which lead to quicker recovery and return to daily activities with no limitations.
5- Minimal post-operation management.
6- Low incidence of short and long term complications compared to traditional surgical procedures.
Common complications of traditional procedures are cataract, endopthalmitis,phlebitis,wound leak,hypotony and choroidal hemorrhage and detachments.
What are the Disadvantages of this procedure?
1- More expensive than traditional procedure.
2- The duration of this procedure takes approximately 30 minutes which is slightly longer than trabeculectomy.
3- The learning curve of this procedure required to master the technique.
What are the Complications of Canaloplasty?
1- Hyphema which is blood in the anterior chamber of the eye.
2- Detachment of Descemet membrane.
These complications rarely occur.
Steps of Canaloplasty
1- Partial thickness scleral flap near the limbus (cornea-scleral junction) is performed.
2- The Canal of Schlemm is identified then intubated with a small tube or microcatheter. This tube has several characteristics which are:
- A diameter of 200 microns.
- A lighted tip to identify its location as it passes through the canal.
- A lumen to allow for the injection of viscoelastic Material (sodium hyaluronate). This material helps to force open the entire length of the canal.
3- This tube will pass 360° clockwise through the canal.
4- Once it passed the full length of canal, a 10'0 Nylon or Prolene suture is tied to the tube.
5- The tube will be pulled 360° anti-clockwise with the suture.
7- The suture will be left in place and tied off to provide tension on the trabecular meshwork which will also force the canal to open.
8- The scleral flap and the conjunctiva are tightly closed to prevent the formation of bleb and also to prevent leakage of aqueous humor.
9- A double sutures technique can also be used to reduce the risk of closure of the canal.