Peter Szurman1,2, Kai Januschowski1,2, Karl Thomas Boden3, Gesine Bettina Szurman1,2. 1. Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, An der Klinik 10, 66280, Sulzbach, Saar, Germany. 2. Centre for Ophthalmology, University Eye Clinic Tuebingen, Tuebingen, Germany. 3. Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, An der Klinik 10, 66280, Sulzbach, Saar, Germany. drkarlboden@googlemail.com.
Abstract
PURPOSE: A modified canaloplasty technique is described that may facilitate the surgical procedure and potentially maximizes the intraocular pressure (IOP)-lowering effect by altering both the trabecular and uveoscleral aqueous outflow. METHODS: The second deeper layer in the modified technique (about 3.5 × 4 mm, Fig. 1a, b) is not prepared in a lamellar fashion, but is cut down full-thickness to the choroid, hence opening the suprachoroidal space. Furthermore, this second deep scleral flap creates an additional aqueous outflow and drainage into the suprachoroidal space, thus possibly lowering the postoperative IOP by improving the natural uveoscleral outflow facility. RESULTS: Seventy-eight eyes operated with this modified technique in the last 12 months were retrospectively analysed. Mean IOP before surgery was 19.10 mmHg and patients applied 3.0 topical medications. Twelve months after surgery, the IOP was 13.5 mmHg and patients applied 1.0 topical medication; 52.6 % of patients did not use any topical therapy. DISCUSSION: The modified dissection canaloplasty technique potentially improves the IOP-lowering effect due to the creation of additional suprachoroidal drainage and simplifies the most complicated step of the surgery, as the scleral spur and the Schlemm's canal can be located using suprachoroidal access.
PURPOSE: A modified canaloplasty technique is described that may facilitate the surgical procedure and potentially maximizes the intraocular pressure (IOP)-lowering effect by altering both the trabecular and uveoscleral aqueous outflow. METHODS: The second deeper layer in the modified technique (about 3.5 × 4 mm, Fig. 1a, b) is not prepared in a lamellar fashion, but is cut down full-thickness to the choroid, hence opening the suprachoroidal space. Furthermore, this second deep scleral flap creates an additional aqueous outflow and drainage into the suprachoroidal space, thus possibly lowering the postoperative IOP by improving the natural uveoscleral outflow facility. RESULTS: Seventy-eight eyes operated with this modified technique in the last 12 months were retrospectively analysed. Mean IOP before surgery was 19.10 mmHg and patients applied 3.0 topical medications. Twelve months after surgery, the IOP was 13.5 mmHg and patients applied 1.0 topical medication; 52.6 % of patients did not use any topical therapy. DISCUSSION: The modified dissection canaloplasty technique potentially improves the IOP-lowering effect due to the creation of additional suprachoroidal drainage and simplifies the most complicated step of the surgery, as the scleral spur and the Schlemm's canal can be located using suprachoroidal access.
Authors: Richard A Lewis; Kurt von Wolff; Manfred Tetz; Norbert Korber; John R Kearney; Bradford Shingleton; Thomas W Samuelson Journal: J Cataract Refract Surg Date: 2007-07 Impact factor: 3.351
Authors: Thomas Klink; Johannes Sauer; Norbert J Körber; Franz Grehn; Martin M Much; Luisa Thederan; Juliane Matlach; Josefina Parente Salgado Journal: Clin Ophthalmol Date: 2014-12-18