Nova Eye Medical reported the recent publication of three investigator-led, retrospective case series which evaluated the long-term effectiveness of canaloplasty in patients with open-angle glaucoma (OAG) over 36- and 48-month periods, and in post-keratoplasty patients.

Performed by Mark J. Gallardo, MD, and published in the March 2022 issue of Ophthalmology Glaucoma, the 36-month case series demonstrated a significant reduction in mean IOP as compared to baseline, along with a significant decrease in the mean number of glaucoma medications, following canaloplasty performed with the iTrack device. 

Performed by Norbert Koerber, MD, FEBO, and Simon Ondrejka, MD, and published in the April 2022 issue of Klinische Monatsblätter für Augenheilkunde, the 48-month case series demonstrated a significant reduction in mean IOP as compared to baseline, along with a significant decrease in the mean number of glaucoma medications, following canaloplasty performed with the iTrack device. An internationally renowned glaucoma surgeon and one of the pioneers of the canaloplasty procedure, Prof. Koerber has been using the iTrack device in clinical practice for nearly two decades.

Together, these publications raise awareness of canaloplasty, a procedure that acts on all aspects of the conventional outflow system (trabecular meshwork, Schlemm canal, and the collector channels) and its role in the glaucoma treatment paradigm.

Forty-four eyes of 44 patients were included in the Gallardo study. 23 eyes underwent iTrack as a standalone procedure (iTrack-alone group) and 21 eyes underwent iTrack in combination with cataract surgery (iTrack+phaco group). There was a statistically significant reduction in IOP and number of medications between baseline and all post-operative visits (P<0.0001) either when canaloplasty was performed as a standalone procedure or in combination with cataract surgery. 

The study by Prof. Koerber corroborated the findings of Dr. Gallardo, demonstrating that the comparable reduction in IOP and medications is sustained 48 months postoperatively. Indeed, performed as a standalone procedure (n=4) or in conjunction with cataract surgery (n=23), canaloplasty demonstrated a sustained reduction in IOP and in medication burden 4 years after surgery. In Prof. Koerber’s cohort, approximately half of the eyes in the case series (n=13) were defined as controlled with medications at baseline, with an IOP equal to or less than 18 mmHg. In these eyes, canaloplasty was performed to reduce patient reliance on medications due to intolerance or noncompliance, while maintaining IOP within target range. The mean number of medications for this group was 1.77 ±0.93 at baseline and reduced by more than 50% to 0.83 ±0.98 at 48 months. In addition, 50% of these eyes were on zero medications at the 48-month follow-up.

Led by Kamran M. Riaz, MD, and Mahmoud A. Khaimi, MD, a novel study on canaloplasty performed in 17 eyes post-keratoplasty has shed new light on the safety profile of the procedure in patients with fragile corneas. Published in the March 2022 issue of Cornea, this case series demonstrated that canaloplasty performed via an ab-interno surgical technique effectively reduced IOP and maintained graft survivability in post-keratoplasty eyes for at least 12 months. The reduction in IOP observed in post-keratoplasty eyes is consistent with the results in non-keratoplasty eyes, as per the published literature. While a variety of MIGS procedures may be considered in post-keratoplasty patients, the study demonstrated that canaloplasty is associated with a low risk of complications in this unique and challenging patient population. 

The frequency of surgical and postsurgical complications reported was low in all studies, with no serious adverse events recorded.