Descemet's Membrane Detachment during Phacocanaloplasty: Case Series and In-Depth Literature Review

This article presents three cases of Descemet's membrane detachment (DMD) occurring during 'ab externo' phacocanaloplasty procedures in three patients with uncontrolled primary open-angle glaucoma (OAG) and discusses the management of this condition by reviewing the available literature. Following a successful 360° cannulation of Schlemm's canal (SC), the microcatheter was withdrawn while an ophthalmic viscosurgical device (OVD) was injected into the canal. During passage through the inferonasal quadrant, a spontaneous separation of the posterior layer of the cornea was observed. Each case was managed differently after diagnosis, with the third case being drained intraoperatively based on experience gained from the previous cases. On the first postoperative day, slit-lamp biomicroscopy (BMC) revealed multiple DMDs in case one and a hyphema in the lower third of a deep anterior chamber. In the other two cases, a single DMD was observed. The second case developed hemorrhagic Descemet membrane detachment (HDMD), while the other two were non-hemorrhagic. In all three cases, anterior segment optical coherence tomography (AS-OCT) revealed the presence of retrocorneal hyperreflective membranes indicative of DMDs. These membranes were located in the periphery of the cornea and did not impact the visual axis. After evaluation, a small incision was made in the inferotemporal DMD of the first case. However, for the two remaining cases, a strategy of watchful waiting was deemed appropriate due to the location and size of the DMDs, as they did not affect the best-corrected visual acuity (BCVA). Over time, the patients demonstrated progressive improvement with a gradual reduction in the size of the DMDs.

Evaluation of the Efficacy and Safety of Canaloplasty and iStent Bypass Implantation in Patients with Open-Angle Glaucoma: A Review of the Literature

The aim of the paper was to evaluate the efficacy and safety of minimally invasive antiglaucoma procedures: Canaloplasty and iStent bypass implantation with and without phacoemulsification in patients with primary open-angle glaucoma (POAG). A systematic review of the recent literature was performed based on the PubMed, Google Scholar, Web of Science and Scopus databases. The effectiveness of the procedures was evaluated based on the reduction of intraocular pressure (IOP) and the amount of antiglaucoma medication used before and after surgery. Safety of the treatments was evaluated based on the number of incidences of certain intraoperative and postoperative complications. Independent prospective randomized controlled trials (PRCTs) have demonstrated that both procedures, canaloplasty and iStent implantation, are effective in reducing IOP and the amount of antiglaucoma medication. Considering the safety profile of these procedures, both canaloplasty and iStent implantation are associated with low rates of postoperative complications and have similar safety profiles. Further studies are needed to confirm the results of our analysis, including a high-quality randomized controlled trial comparing canaloplasty and iStent bypass implantation

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

PURPOSE

To assess the safety and efficacy of phaco-canaloplasty in patients with concomitant advanced pseudoexfoliation glaucoma and cataract.

MATERIAL AND METHODS

The study included 56 patients (57 eyes) who underwent phacoanaloplasty guided by Glaucolight microcatheter. All patients were followed up for 48 months. Visual acuity, changes of intraocular pressure (IOP), use of glaucoma medications, incidence of complications, as well as postsurgical interventions were examined.

RESULTS

Mean preoperative IOP decreased significantly from 29.8 mmHg (15.8-61.6) with a mean of 1.92 (0-3) glaucoma drops to 12.9 mmHg (11.0-19.6) with a mean of 0.12 (0-3) drops respectively 48 months after phacocanaloplasty. Mean visual acuity increased from preoperative 0.15 (0.01-0.8) to 0.6 (0.01-1.2). The most frequent complications included intraoperative perforation of Descemet's membrane (4 eyes, 7%) and hyphema (37 eyes, 65%), IOP spikes (4 eyes, 7%) and inflammation (4 eyes, 7%) in the early postoperative period.

CONCLUSION

Phacocanaloplasty in eyes with concomitant advanced pseudoexfoliation glaucoma and cataract re-establishes the natural outflow system and leads to significant IOP reduction with minimal risk of intra- and postoperative complications.

The effect of canaloplasty with suprachoroidal drainage combined with cataract surgery - 1-year results

PURPOSE

The purpose of this study was to investigate the safety and efficacy of phacocanaloplasty with suprachoroidal drainage (PCscD) and to compare its intraocular pressure (IOP)-lowering and drug-sparing effect to canaloplasty with suprachoroidal drainage (CscD).

METHODS

The study retrospective interventional study included patients with open-angle glaucoma or secondary forms of glaucoma who underwent either CscD or PCscD between the year 2011 and 2014 in Knappschaft Eye Clinic Sulzbach. Primary end-points were IOP reduction and the number of IOP-lowering medication after 12 months. Secondary end-points were intraoperative and postoperative complications.

RESULTS

A total of 328 eyes were included, 193 were treated with CscD and 135 underwent PCscD. Canaloplasty with scD achieved an IOP reduction of 37.0% (from 20.9 ± 3.6 mmHg to 13.2 ± 2.6 mmHg) after 1 year, whereas PCscD showed a significant higher reduction of 47.4% (from 23.2 ± 5.1 mmHg to 12.2 ± 1.7 mmHg). Reduction in IOP-lowering medication was higher after PCscD (from 3.6 ± 0.6 to 0.2 ± 0.5) than after CscD (from 3.5 ± 0.8 to 0.7 ± 1.0). Twelve months after surgery 55.5% in the CscD group and 80.2% in the PCscD group were free of IOP-lowering medication. In both groups, no severe or sight-threatening complications occurred.

CONCLUSION

Combining cataract surgery and CscD achieves a higher IOP reduction, and patients postoperatively need less IOP-lowering medication than after CscD alone.