Based on the same principles as angioplasty, iTrack™ is an implant-free glaucoma procedure that combines 360° catheterization and pressurized viscodilation to treat all points of blockage in the conventional outflow system. This is in contrast to other glaucoma procedures which bypass the conventional outflow system, or address only a fraction of this system.
“iTrack™ comprehensively treats outflow locations, which is why it is my first go-to glaucoma surgical treatment. I don’t have the diagnostic capability to know where the obstruction is located or what level of resistance exists, and so I like to start off with a procedure that addresses everything.”
With iTrack™ you can target and treat the trabecular meshwork, Schlemm’s canal and the collector channels.
“If we go back and look at our basic science series book and talk about outflow and resistance, we note that there’s disease throughout the entire continuum of the outflow system. It’s actually addressed when we viscodilate with the iTrack™ canaloplasty microcatheter.”
Up to 75% of outflow resistance is localized within the trabecular meshwork.1 The juxtacanalicular portion of the trabecular meshwork, which lies immediately adjacent to Schlemm’s canal, is thought to account for the majority of reduced outflow facility within the trabecular meshwork of POAG eyes. iTrack™ can effectively separate the compressed trabecular plates within the trabecular meshwork.3 – 5
1. Manik Goel, Renata G Picciani, Richard K Lee, and Sanjoy K Bhattacharya. Aqueous Humor Dynamics: A Review. Open Ophthalmol J. 2010; 4: 52 – 59. 2. Stegmann R, Pienaar A, Miller D. Viscocanalostomy for open-angle glaucoma in black African patients. J Cataract Refract Surg. 1999;25(3):316 – 322.3. Grieshaber MC, Pienaar A, Olivier J, Stegmann R. Clinical evaluation of the aqueous outflow system in primary open-angle glaucoma for canaloplasty. Invest Ophthalmol Vis Sci. 2010;51(3):1498 – 1504.4. Smit BA, Johnstone MA. Effects of viscoelastic injection into Schlemm’s canal in primate and human eyes: potential relevance to viscocanalostomy. Ophthalmology. 2002;109(4):786 – 792.
The dimensions of the lumen of Schlemm’s canal are smaller in POAG eyes1 and can account for up to 50% of decreased outflow facility in POAG eyes.2 iTrack™ can effectively break adhesions within Schlemm’s canal, in addition to dilating the canal up to twice its size.3 – 5
1. Johnstone MA, Grant WG. Pressure-dependent changes in structures of the aqueous outflow system of human and monkey eyes. Am J Ophthalmol. 1973;75:365 – 383
2. Allingham RR, de Kater AW, Ethier CR. Schlemm’s canal and primary open angle glaucoma: correlation between Schlemm’s canal dimensions and outflow facility. Exp Eye Res. 1996;62(1):101 – 109.
3. Stegmann R, Pienaar A, Miller D. Viscocanalostomy for open-angle glaucoma in black African patients. J Cataract Refract Surg. 1999;25(3):316 – 322.
4. Grieshaber MC, Pienaar A, Olivier J, Stegmann R. Clinical evaluation of the aqueous outflow system in primary open-angle glaucoma for canaloplasty. Invest Ophthalmol Vis Sci. 2010;51(3):1498 – 1504.
5. Smit BA, Johnstone MA. Effects of viscoelastic injection into Schlemm’s canal in primate and human eyes: potential relevance to viscocanalostomy. Ophthalmology. 2002;109(4):786 – 792.
Up to 90% of collector channels may be blocked by herniations of the trabecular meshwork in POAG eyes.1,2 These herniations into the collector channels result in increased outflow resistance.1,2 iTrack™ can effectively push out herniations out of the collector channels and dilate the collector channels to reduce outflow resistance.3 – 5
1. Gong H, et al. Reduction of the available area for Aqueous humor outflow and increase in meshwork herniations into collector channels following acute IOP elevation in bovine eyes. Invest. Ophthalmol Vis Sci 2008; 49:5346 – 5352.
2. Gong H and Francis A: Schlemm’s Canal and Collector Channels as Therapeutic Targets. In Innovations in Glaucoma Surgery, Samples JR and Ahmed I eds. Chapter 1, page 3 – 25, Springer New York, 2014.Stegmann R, Pienaar A, Miller D. Viscocanalostomy for open-angle glaucoma in black African patients. J Cataract Refract Surg. 1999;25(3):316 – 322.
3. Grieshaber MC, Pienaar A, Olivier J, Stegmann R. Clinical evaluation of the aqueous outflow system in primary open-angle glaucoma for canaloplasty. Invest Ophthalmol Vis Sci. 2010;51(3):1498 – 1504.
4. Smit BA, Johnstone MA. Effects of viscoelastic injection into Schlemm’s canal in primate and human eyes: potential relevance to viscocanalostomy. Ophthalmology. 2002;109(4):786 – 792.
1. Stegmann R, Pienaar A, Miller D. Viscocanalostomy for open-angle glaucoma in black African patients. J Cataract Refract Surg. 1999;25(3):316 – 322.2. Grieshaber MC, Pienaar A, Olivier J, Stegmann R. Clinical evaluation of the aqueous outflow system in primary open-angle glaucoma for canaloplasty. Invest Ophthalmol Vis Sci. 2010;51(3):1498 – 1504.3. Gillman K, Mansouri K, Ambresin A, Bravetti G, Mermoud A. A Prospective Analysis of iStent Inject Microstent Implantation: Surgical Outcomes, Endothelial Cell Density, and Device Position at 12 Months. J Glaucoma. Volume 29, Number 8, August 2020.4. Shiba D, Hosoda S, Yaguchi S, Ozeki N, Yuki K, Tsubota K. Safety and Efficacy of Two Trabecular Micro-Bypass Stents as the Sole Procedure in Japanese Patients with Medically Uncontrolled Primary Open-Angle Glaucoma: A Pilot Case Series. J Ophthalmol. 2017; 2017: 9605461.5. Popovic M, Campos-Moller X, Saheb H, Ahmed IIK. Efficacy and Adverse Event Profile of the iStent and iStent Inject Trabecular Micro-bypass for Open-angle Glaucoma: A Meta-analysis. J Curr Glaucoma Pract 2018;12(2):67 – 84. 6. ElMallah MK, Seibold LK, Kahook MY et al. 12-Month Retrospective Comparison of Kahook Dual Blade Excisional Goniotomy with iStent Trabecular Bypass Device Implantation in Glaucomatous Eyes at the Time of Cataract Surgery. Adv Ther 36, 2515 – 2527 (2019).7. Gallardo MJ, Supnet RA, Ahmed IIK. Viscodilation of Schlemm’s canal for the reduction of IOP via an ab-interno approach. Clinical Ophthalmology. Vol 12. August 2018.8. Source: Cha ED, Xu J, Gong H. Variations in active areas of aqueous humor outflow through the trabecular outflow pathway. Presented at ARVO2015.)9. Allingham RR, de Kater AW, Ethier CR. Schlemm’s canal and primary open angle glaucoma: correlation between Schlemm’s canal dimensions and ouflow facility. Exp Eye Research 1996;62:101 – 1
10. Gallardo, MJ. 24-Month Efficacy of Viscodilation of Schlemm’s Canal and the Distal Outflow System with iTrack Ab-Interno Canaloplasty for the Treatment of Primary Open-Angle Glaucoma. Clinical Ophthalmology 2021:151591 – 1599.
11. Kazerounian S, Zimbelmann M, Lörtscher M, et al. Canaloplasty ab interno (AbiC) — 2‑Year-Results of a Novel Minimally Invasive Glaucoma Surgery (MIGS) Technique. Klinische Monatsblatter fur Augenheilkunde. 2020 Nov. DOI: 10.1055/a‑1250 – 8431.
12. D.M. Lubeck, MD, and R.J. Noecker, MD, unpublished data, 2020; accepted for presentation at ASCRS2021.
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