Relative safety establishes role for canaloplasty

San Francisco-Canaloplasty is an effective procedure for achieving sustained lowering of IOP and medication burden in patients with open-angle glaucoma, and its safety profile makes it a good contender for competing with trabeculectomy, said Richard A. Lewis, MD.

Dr. Lewis, a glaucoma specialist in private practice, Sacramento, CA, noted that canaloplasty is indicated only for treatment of open-angle glaucoma, and because it has a learning curve, it will probably not become a primary or even mainstream procedure. Nevertheless, he said that canaloplasty seems to be gaining popularity and can play an important role in glaucoma surgical management.

“Canaloplasty is not a minimally invasive glaucoma procedure and it won’t compete as such,” Dr. Lewis said. “However, it is leading the way to minimally invasive surgeries.

“Experience with canaloplasty has helped shift the surgical focus from creating a full- or partial- thickness fistula to interest in Schlemm’s canal,” he said. “For that reason, I think it has been an important development that will lead us to the next segment in the evolution of glaucoma operations.”

Dr. Lewis said there is a growing body of literature demonstrating the efficacy and safety of canaloplasty, including a recent publication on which he was the lead author that reported IOP lowering was sustained to 3 years. However, data from longer follow-up are still needed.

“One of the criticisms of canaloplasty is that it fails over time so that other intervention becomes necessary,” he said. “However, if you look at outcomes after trabeculectomy, it has a failure rate of 50% to 60% at 3 to 5 years.

“All of our surgical procedures for glaucoma fail at some point, and canaloplasty is probably no different in that regard,” Dr. Lewis said. “However, it is still a good choice for a patient with moderate open-angle disease.”