DONATE NOWCanaloplasty Glaucoma Surgery Overview
Canaloplasty glaucoma surgery reduces IOP by restoring the trabeculocanalicular outflow pathway.
What is Canaloplasty?
Canaloplasty is circumferential dilation and stenting of Schlemm’s canal with a viscoelastic agent and a Prolene suture. Schlemm’s canal is the drainage channel into which intraocular fluid drains after passing through the pores of the trabecular meshwork. It is a circular microscopic canal that lies within the tissues at the junction of the cornea and the sclera.
Recent advances in technology have enabled the development of a 250 micron flexible microcatheter with an illuminated tip (iTrack™, iScience Interventional, Menlo Park, CA) that passes through Schlemm’s canal. The availability of this microcatheter along with advances in ocular ultrasound and viscoelastics have lead to the development of Canaloplasty, as a promising non-penetrating surgical technique for lowering intraocular pressure in patients with open angle glaucoma.
Who is a Good Candidate for Canaloplasty?
Surgeons use canaloplasty to treat open-angle glaucoma. They do not perform it on patients with angle recession, neovascular glaucoma, chronic angle closure, narrow-angle glaucoma, narrow inlets with plateau iris, or previous surgery that prevents 360-degree catheterization of Schlemm’s canal.
How Does it Work?
Canaloplasty reduces IOP by restoring the trabeculocanalicular outflow pathway. It increases the flow of aqueous humor from the anterior chamber, through the trabecular meshwork and Descemet’s window, into and around Schlemm’s canal, and out through the collector channels (Fig.3). The hypothesis is the suture tensioning acts similar to pilocarpine increasing trabecular meshwork permeability. This procedure routes fluid through normal physiological pathways and does not create a ‘bleb’ on the eye’s surface.
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What Steps Does a Canaloplasty Procedure Involve?
After you and your doctor decide to proceed with Canaloplasty, our preoperative scheduling nurse will provide detailed instructions on preparing for surgery and arriving at the operating room. For more information, see Preoperative Instructions.
This outpatient procedure takes place in an ambulatory surgery center. Typically, the surgery lasts less than one hour and uses local anesthesia with intravenous sedation. Afterward, your ophthalmologist covers the eye with a patch and plastic shield overnight. The next morning, your ophthalmologist removes the patch and examines the eye. Then, your doctor prescribes eye drops to prevent infection and reduce inflammation. For more details, see Postoperative Instructions.
During the weeks following surgery, your ophthalmologist will monitor your eye closely and perform frequent examinations. Additionally, your doctor may use high-resolution ultrasound to visualize Schlemm’s canal and assess the extent of its dilation. Healing may take up to 12 weeks, and during this time, your intraocular pressure and vision may fluctuate. Consequently, you will usually be ready to update your glasses prescription around eight weeks after surgery.