[Late results of phaco-canaloplasty in patients with concomitant advanced pseudoexfoliation glaucoma and cataract]

Canaloplasty in Pseudoexfoliation Glaucoma. Can It Still Be Considered a Good Choice?

Purpose: The aim of this study was to assess the long-term outcomes of canaloplasty surgery in pseudoexfoliation glaucoma (PEXG) patients. Material and Methods: A total of 116 PEXG patients with an intraocular pressure (IOP) > 21 mm/Hg and maximum tolerated local medical therapy who underwent canaloplasty from February 2008 to January 2022 were considered. Every six months, all subjects underwent a complete ophthalmic examination. The period of follow-up ranged from 2 to 167 months. Inclusion criteria included only patients for whom the entire procedure could be completed with a follow-up of at least 2 years. Results: Amongst the 116 PEXG patients, the entire procedure could not be performed in 10 eyes (8.6%), and thus they were not considered in the analysis. Twenty-three patients did not reach the two-year follow-up and another 16 patients during this time period were lost. A total of 67 patients with a mean follow-up of 49 ± 32.3 months were considered in the analysis. The pre-operative mean IOP was 31.2 ± 8.7 mm/Hg (range 20−60). The mean IOP at the two-year follow-up was 17.2 ± 6.7 mmHg, with a mean reduction from baseline of 44.9%. After two years, the qualified success rates according to three different criteria (IOP ≤ 21, ≤18 and ≤16 mmHg) were 80.6%, 73.1% and 61.0%, respectively. The total number of medications used pre- and at the follow-up at 2 years was 3.5 ± 0.8 and 1.2 ± 1.4, respectively. Early complications included: hyphema, in about 30% of cases; Descemet membrane detachment (4.9%); and IOP spikes > 10 mmHg (9.7%). A late failure with an acute IOP rise of up to 50 mmHg was observed in 41 cases (61.2%) after 3 to 72 months. Conclusions: Long-term post-operative outcomes of canaloplasty in PEXG patients appear to be quite good on average; however, an acute rise in IOP can be observed in more than 60% of the cases after a long period of satisfactory IOP control. For this reason, canaloplasty may not be suitable in eyes with PEXG, especially in patients with severe functional damage.

Comparison of performance between two microcatheter systems in ab externo canaloplasty: A retrospective comparison study

Purpose:

To compare the performance of two different microcatheter systems, iTrack™ 250A and Glaucolight, in ab externo canaloplasty in three major categories: intraocular pressure reduction, drug therapy reintroduction, and evaluation of viscodilation over distension of the inner wall of Schlemm’s canal.

Methods:

A total of 56 and 46 eyes from different glaucoma types underwent ab externo canaloplasty using two different microcatheter systems. Group formation was made according to microcatheter system used. Kaplan–Meier test was performed for drug therapy reintroduction in relation to the two microcatheters. Tests of between-subject effects in two-way analysis of variance evaluated the efficacy of the two microcatheters and their features in relation to intraocular pressure reduction.

Results:

Kaplan–Meier test was not statistically significant (p = 0.20) regardless of microcatheter system. Tests of between-subject effects in relation to intraocular pressure reduction was not statistically different between the two microcatheters (p = 0.26) or between microcatheter and follow-up (p = 0.90). Intraocular pressure reduction in different glaucoma type was statistically significant during the follow-up period and glaucoma types showed different results between them in relation to follow-up (p < 0.001 and p = 0.002, respectively), but the pairwise comparison was not statistically important (p = 0.42). Intraocular pressure reduction was better in pseudophakic eyes in comparison with phakic eyes (p = 0.03), but the selection of microcatheter seemed not to affect this result (p = 0.11 and p = 0.32, respectively).

Conclusion:

Both microcatheter systems performed equal in terms of intraocular pressure reduction. Drug therapy reintroduction was not affected by the selection of the two microcatheters. Different types of glaucoma responded different to canaloplasty. Pseudophakic eyes responded better to treatment than phakic eyes, but the microcatheter selection seemed not affect this result.