Canaloplasty for mild-moderate glaucoma

Based on the same principles as angioplasty, canaloplasty uses breakthrough microcatheter technology to enlarge your eye’s natural drainage system, improving outflow and lowering intraocular pressure. 

Canaloplasty can also free you from the financial and lifestyle burdens of glaucoma medications. It is important to note that Canaloplasty acts to restore the eye’s natural outflow system and does not require a permanent implant or device in your eye.

  • Restorative treatment of eye’s natural drainage system
  • Sustained reduction of pressure in the eye
  • Reduced dependence on expensive medications
  • Minimally invasive for quicker recovery and return to daily activities
  • Limited risk of complications versus traditional surgical alternatives
  • No need for a permanent implant or device in your eye
  • No limitations on your favorite activities

First, your surgeon will make a small incision in the eye. A microcatheter designed specifically for canaloplasty is then inserted into the eye’s circumferential drainage canal, which may be reduced in size or closed due to the high pressure in your eye. Your surgeon will advance the microcatheter 360 degrees around the canal to open up the channel and enlarge it. Once the end of the catheter has circumnavigated to its point of entry, the microcatheter tip is slowly pulled back while sterile, viscoelastic gel is injected into the canal to dilate it to 2 – 3 times its normal size. Enlarging and flushing through the drainage canal and adjacent outflow channels helps the aqueous fluid to drain properly. The microcatheter is then removed from the eye. It is important to note that there are no permanent implants or devices left in the eye.

By restoring your eye’s natural drainage system, the pressure inside your eye is usually lowered.

One to three days after the procedure, your intraocular pressure should drop significantly. And of course, your physician will want to re-check the treated eye during periodic follow-up visits.

No. During the surgery your eye will be anesthetized. Post-surgery your surgeon will prescribe eye drops to reduce inflammation and to prevent pain.

It is necessary to first undergo an ophthalmic examination to determine your eligibility for canaloplasty. Canaloplasty is an effective surgical option for the majority of glaucoma patients. If you fit into any of the following categories, you’re a good candidate for canaloplasty:

  • If you have primary open-angle, pseudoexfoliation, or pigmentary glaucoma. (If you’re not sure, ask your ophthalmologist.)
  • If you are intolerant of glaucoma medications, or have difficulty taking them as prescribed.
  • If you are about to have cataract surgery and wish to use this opportunity to reduce the number of glaucoma medications you are currently taking.
  • If it is difficult for you to commit to regular follow-up treatments, due to finances, lack of transportation, or other limitations.
  • If you have a history of failed ALT (argon laser trabeculoplasty) treatments.
  • Canaloplasty is also suitable for patients who wear contact lenses. Patients with contact lenses are unable to undergo the traditional forms of glaucoma surgery (trabeculectomy or shunt).

Please note that canaloplasty is not suitable for patients with neovascular or chronic angle-closure glaucoma.

One of the key advantages of canaloplasty is its high safety profile. It is associated with significantly fewer risks, both in number and severity, than traditional glaucoma surgeries. It is important to note, however, that all surgeries have risks associated with them. The most common risks associated with canaloplasty are:

  • Bleeding in the Eye
  • Intraocular Pressure Spikes”
  • The Formation of a Bleb
  • Hypotony (IOP too low)

A key benefit of canaloplasty is that is does not preclude any other form of glaucoma treatment. If the procedure is not successful, your surgeon may elect to perform laser-based treatment, such as SLT, or conventional glaucoma surgery (trabeculectomy). Medication may also be an option.

Rather than trying to mechanically change or bypass the pathway of aqueous outflow, canaloplasty acts to restore the natural outflow process by targeting all aspects of the outflow system. That is, the trabecular meshwork, Schlemm canal, and the collector channels.”

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Canaloplasty for severe glaucoma

Unlike traditional glaucoma surgery or trabeculectomy, which bypasses the eye’s natural drainage channels, xanaloplasty restores the natural outflow pathways in order to reduce elevated intraocular pressure (IOP). It is a non-penetrating’ glaucoma surgery that does not require the creation of a permanent hole in the eye, so does not result in a bleb’ (blister). Canaloplasty has an excellent safety profile with minimal post-operative follow-up and faster recovery time.

Most glaucoma treatments fail to completely address the natural outflow system and may even disturb the natural outflow function. Unlike traditional glaucoma surgeries (trabeculectomy and tube shunts), which bypass the natural outflow system, canaloplasty works by restoring the natural ocular outflow function in four key steps:

Step 1
The trabecular meshwork is more permeable due to microperforations caused by injection of viscoelastic and and it is stretched by a circumferential suture which holds the meshwork open to allow the fluid to pass through.

Step 2
The canal into which the fluid drains, known as Schlemm’s canal, is dilated by injection of a visco-elastic substance so that the flow is enhanced.

Step 3
The dilation of the canal also opens up the collector channels which transport the fluid into the circulation system.

Step 4
An additional fluid reservoir is created within the ocular wall. This reservoir can be stimulated to release more fluid if necessary in the longer term.

After the surgery, you may feel some slight irritation under the eyelid until the sutures have fully resorbed. You may also see some bleeding in the front of the eye. This is usually a sign that the connection between the circulatory system and the aqueous outflow has been restored and that the surgery has been successful. Your surgeon will schedule one or more post-operative visits to ensure that everything is going smoothly and to check your IOP, and will prescribe drops to soothe your eye and prevent infection. You can resume normal, day-to-day activities, such as watching TV, immediately following treatment.

It is important to remember that managing glaucoma is a lifelong process: even after canaloplasty and other glaucoma treatments, you will need to continue to visit your ophthalmologist every three to six months.

One of the key advantages of canaloplasty is its high safety profile. It is associated with significantly fewer risks, both in number and severity, than traditional glaucoma surgeries. It is important to note, however, that all surgeries have risks associated with them.

The most common risks of canaloplasty are:

Bleeding in the Eye
Almost 30% of people who have Canaloplasty have some bleeding in the front of the eye. This bleeding (called a hyphema or microhyphema) resolves with time and rarely causes any permanent reduction in vision. It is a good prognosis for surgery because it is a sign that contact has been established with the blood circulation system.

Intraocular Pressure Spikes’
About 5% of patients will record a post-surgery IOP that is higher than it was before surgery. This is almost always transient and of no consequence.

The Formation of a Bleb
Approximately 6% of patients will experience the formation of a bleb (blister) on the surface of the eye in the area of the incision. It is important to note that with trabeculectomy, the formation of a (stable) bleb is necessary for success and is a necessary side effect of the surgery. With Canaloplasty, it is not a desired outcome but it rarely limits the effectiveness of the surgery.

Descemet’s Membrane Separation
In approximately 3% of patients the viscoelastic can dissect beneath Descemet’s Membrane (the thin film on the back of the cornea) and corneal stroma. In the majority of cases this condition will resolve on its own. If it does not improve spontaneously, your surgeon may inject a gas bubble into your eye to press this membrane back against the cornea.

Hypotony (IOP too low)
In some cases, IOP may drop too low – below 5mmHg – following the procedure. This condition is rare with Canaloplasty and only one person in two hundred (0.5%) would be expected to have prolonged hypotony. However at least one out of every ten patients (10%) is likely to experience hypotony following trabeculectomy.

It is necessary to first undergo an ophthalmic examination in order to determine your eligibility for canaloplasty.

Canaloplasty is indicated for the reduction of elevated IOP in open-angle glaucoma (OAG) patients, including pigmentary glaucoma (PG), pseudoexfoliation glaucoma (PXF), normal tension glaucoma (NTG) and juvenile glaucoma. While it can be performed across the entire glaucoma treatment spectrum, it is particularly well suited to patients who have difficulty administering eye drops, or for whom medications or laser treatment are no longer effective. It is also a good option for patients who are reluctant to undergo the more invasive trabeculectomy surgery, which is often reserved for the end-stage of the disease. Trabeculectomy can severely limit your ability to participate in certain sports. No such limitation exists with canaloplasty. Once healed, patients who have had Canaloplasty are able to return to their previous active lifestyles without restriction or limitation.

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