Today’s glaucoma specialists are more fortunate than ever—as managing their patients’ condition no longer requires a reliance on medication at one end of the treatment spectrum, and tube shunts and trabeculectomy at the other.
It is undeniable that trabeculectomy and tube shunts are effective at lowering IOP and slowing disease progression, and undoubtedly play a key role in the treatment of glaucoma. However, they may increase the risk of numerous peri- and postoperative complications.
Since these complications can be difficult and time-consuming to manage, surgeons are increasingly turning to less-invasive procedures that deliver reductions in IOP and medication use and may be associated with fewer complications.
Restoring outflow with MIGS
Another limitation of filtering surgery is that it works by circumventing—rather than restoring—the natural outflow pathway, which consists of the trabecular meshwork, Schlemm’s canal, and collector channels.
The past several years have seen the arrival of numerous devices and techniques for minimally invasive glaucoma surgeries (MIGS), which address specific, different aspects of the ocular outflow system.
One of the most interesting forms of MIGS, however, is ab-interno canaloplasty (ABiC).
An evolution of traditional canaloplasty, ABiC addresses all aspects of the outflow pathway. It is also the only non-ablative FDA-approved MIGS indicated for use outside of cataract surgery, and is the only MIGS to address the collector channels, which have been shown to play a key role in blocking aqueous outflow.1,2
Like its predecessor (canaloplasty), ABiC uses a patented microcatheter (iTrack, Ellex Medical Lasers Ltd.) to provide 360° viscodilation of Schlemm’s canal through a clear corneal incision. Unlike canaloplasty, the procedure does not require a tensioning suture. ABiC also preserves conjunctival tissue, allowing surgeons to perform future procedures if necessary.
In the past, if a patient was on maximum pharmacologic therapy, had an above-target IOP, and was at risk of progression, I would go straight to filtering surgery.