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.