J Matlach1, T Klink. 1. NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, 162 City Road, EC1V 2PD, London, UK, juliane.matlach@moorfields.nhs.uk.
Abstract
BACKGROUND: Trabeculectomy provides an excellent reduction of intraocular pressure (IOP) and is the reference technique in the treatment of glaucoma patients. Canaloplasty is a relatively new surgical non-penetrating procedure for restoring the natural outflow pathway of aqueous humour. The aim of canaloplasty is to permanently distend the collapsed Schlemm's canal with the placement of a 360° intracanalicular tension suture. OBJECTIVES: This review article describes the comparison between trabeculectomy and canaloplasty with and without cataract surgery. MATERIAL AND METHODS: Original studies, case reports and reviews are described and the results are discussed. RESULTS: Although canaloplasty may not be as effective in reducing IOP, trabeculectomy can be associated with severe vision-threatening complications however, the combination of canaloplasty with cataract surgery achieves a higher IOP reduction than canaloplasty alone. In contrast, trabeculectomy alone provides better IOP control than phacotrabeculectomy due to a higher risk of early bleb scarring induced by an increased intraocular inflammatory reaction. CONCLUSION: If a higher postoperative IOP is acceptable and additional topical glaucoma medication tolerable, canaloplasty can be considered as an alternative to trabeculectomy as the incidence of complications is low and postoperative care less intensive. Canaloplasty may also be suitable for patients with high risk of bleb failure and early glaucoma with a target IOP not necessarily requiring a filtering procedure. Therefore, canaloplasty offers a treatment option for the management of open-angle glaucoma, especially in combination with cataract surgery.
BACKGROUND: Trabeculectomy provides an excellent reduction of intraocular pressure (IOP) and is the reference technique in the treatment of glaucomapatients. Canaloplasty is a relatively new surgical non-penetrating procedure for restoring the natural outflow pathway of aqueous humour. The aim of canaloplasty is to permanently distend the collapsed Schlemm's canal with the placement of a 360° intracanalicular tension suture. OBJECTIVES: This review article describes the comparison between trabeculectomy and canaloplasty with and without cataract surgery. MATERIAL AND METHODS: Original studies, case reports and reviews are described and the results are discussed. RESULTS: Although canaloplasty may not be as effective in reducing IOP, trabeculectomy can be associated with severe vision-threatening complications however, the combination of canaloplasty with cataract surgery achieves a higher IOP reduction than canaloplasty alone. In contrast, trabeculectomy alone provides better IOP control than phacotrabeculectomy due to a higher risk of early bleb scarring induced by an increased intraocular inflammatory reaction. CONCLUSION: If a higher postoperative IOP is acceptable and additional topical glaucoma medication tolerable, canaloplasty can be considered as an alternative to trabeculectomy as the incidence of complications is low and postoperative care less intensive. Canaloplasty may also be suitable for patients with high risk of bleb failure and early glaucoma with a target IOP not necessarily requiring a filtering procedure. Therefore, canaloplasty offers a treatment option for the management of open-angle glaucoma, especially in combination with cataract surgery.
Authors: Richard A Lewis; Kurt von Wolff; Manfred Tetz; Norbert Koerber; John R Kearney; Bradford J Shingleton; Thomas W Samuelson Journal: J Cataract Refract Surg Date: 2011-04 Impact factor: 3.351
Authors: Henry D Jampel; Jason F Solus; Patricia A Tracey; Donna L Gilbert; Tara L Loyd; Joan L Jefferys; Harry A Quigley Journal: Ophthalmology Date: 2012-01-14 Impact factor: 12.079