Can Schlemm’s canal surgery be glaucoma’s Holy Grail?

San Diego-Glaucoma surgeons are constantly clamoring for better surgical techniques. These new procedures will have to include less follow-up, fewer complications, and be technically accessible, said Barbara Smit, MD, PhD.

Traditional incisional glaucoma surgery shunts fluid to the subconjunctival space and provides a route for aqueous to leave the eye by bypassing the normal outflow system and avoiding sources of resistance to outflow.

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“We all perform it, but it comes with numerous potential complications,” including hypotony, scarring, choroidal hemorrhage, and endophthalmitis, said Dr. Smit during Glaucoma Day at the 2015 meeting of the American Society of Cataract and Refractive Surgery.

One of her patients, “Norm,” had undergone bilateral trabeculectomy in the 1990s, and developed bacterial endophthalmitis in one eye in 1999 (now no light perception in that eye). He then developed fungal endophthalmitis in his other eye in 2004 (now counting fingers vision only).

“Norm would like to inspire us to do better,” she said. With an aging population, glaucoma specialists are going to be inundated with patients and the demand for better procedures cannot go unanswered.

These new procedures will have to include less follow-up, fewer complications, and be technically accessible, she said.

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