Canaloplasty becoming an important contender in glaucoma surgery arena

April 4, 2008

Canaloplasty with tensioning suture placement is growing in popularity as a result of a combination of factors, including a successful training program, an improved reimbursement picture, and favorable long-term data, said Richard A. Lewis, MD.

Canaloplasty with tensioning suture placement is growing in popularity as a result of acombination of factors, including a successful training program, an improved reimbursementpicture, and favorable long-term data, said Richard A. Lewis, MD.

Canaloplasty is a nonpenetrating procedure performed under a scleral flap in which amicrocatheter (iTrack, iScience) is used with an ophthalmic viscosurgical device (Healon GV,Advanced Medical Optics) to viscodilate the canal prior to passing a tensioning suture throughthe circumference of Schlemm's canal. The procedure is indicated for the treatment ofopen-angle glaucoma, especially in patients expected to be at high risk for trabeculectomyfailure or in those where there is increased concern about further loss of vision, said Dr.Lewis, a private practitioner in Sacramento, CA.

Recently published clinical results from a prospective study including 168 patients showed thatat baseline, mean IOP was 23.9 mm Hg with a mean of 1.9 medications used per patient. At 24months, the mean IOP was reduced by 36% to 15.2 mm Hg with patients on an average of 0.6medications. Although complications occurred, there were no cases of flat or shallow anteriorchambers, infections, wound leaks, or choroidal effusion.

So far, 150 surgeons in the United States and 70 surgeons internationally have been trained inthe procedure, and more than 1,500 procedures have been performed worldwide. For reimbursementin the United States, canaloplasty is currently coded as Category III, although there is a planto submit for Category I coding later this year.

"This procedure has progressed to a stage where surgeons have begun to innovate beyond theinitial technique," Dr. Lewis said. "Additional surgical tools will continue to expandmicrocatheter clinical indications and treatment options for glaucoma surgery, and the power ofmicrocatheter-based drug delivery is a particularly exciting and promising technique for all ofophthalmology."