Ab externo canaloplasty results and efficacy: a retrospective cohort study with a 12-month follow-up

Background:The aim of this study is to review the outcomes of canaloplasty versus canaloplasty combined with phacoemulsification in a retrospective cohort study and to evaluate the efficacy of these methods in terms of intraocular pressure(IOP)lowering effect,postoperative complications and additional glaucoma surgery or reintroduction of medical therapy over a 12-month follow-up.Methods:In a retrospective cohort study,602 eyes with primary open angle glaucoma(POAG)were treated with canaloplasty or canaloplasty combined with phacoemulsification.The results were evaluated separately in two main groups;group A canaloplasty(262 eyes)and group B canaloplasty combined with phaco(322 eyes).Each group was then subdivided into three additional groups according to the severity of glaucoma.The criteria for successful treatment were evaluated between three IOP ranges;IOP≤16 mmHg,18 mmHg and 21 mmHg.Complete success was considered the percentage of eyes reaching target IOP with no medication and partial success with medication.Groups A and B subgroups were compared using the Kaplan Meier test.Mean IOP,reduction of antiglaucoma agents and additional IOP lowering methods were also evaluated.The follow-up time was 12 months.Statistical significance was set at p<0.05.Results:An incomplete intraoperative cannulation of Schlemm’s canal resulting in conversion to other glaucoma surgery occurred in 18 eyes(2.99%).In both of the main groups,postoperative hyphema,descemet membrane detachment and transient IOP rise were the most common postoperative complications.The mean IOP in group A and subgroups at 12 months was 13.26±4.5 mmHg,15.19±3.97 mmHg and 18.09±3.75 mmHg.Respectively in group B mean IOP was 14.51±4.69 mmHg,14.40±4.11 mmHg and 14.25±2.76 mmHg.Complete success was achieved in group A in 69.19,74.51 and 74.31%of eyes.In group B complete success was achieved in 81.60,77.33 and 83.33%of eyes respectively.Kaplan Meier between groups A and B was statistically significant for IOP≤16 mmHg and IOP≤21 mmHg(p=0.0041 and p=0.0312),but not for IOP≤18 mmHg(p=0.6935).Partial success for IOP≤16 mmHg was 95.23 and 92.26%,for IOP≤18 mmHg was 91.66 and 90.47%and for IOP≤21 mmHg,90.00 and 93.10%,in groups A and B respectively.Twenty-three eyes received additional surgery(3.93%),10 trabeculectomies and 2 cyclophotocoagulation in group A,and 9 trabeculectomies and 2 cyclophotocoagulation in group B.Conclusion:Canaloplasty and canaloplasty combined with phacoemulsification significantly lower the IOP and have a lower postoperative complication rate.Additional glaucoma surgery or medication following both procedures is necessary if target IOP is unsatisfactory.In this study,canaloplasty combined with phacoemulsification demonstrated superior success rate compared to canaloplasty alone.

Preliminary results of Preserflo Microshunt versus Preserflo Microshunt and Ologen implantation

Purpose:To report preliminary 6-month results on the use of the Preserflo Microshunt implant with and without Ologen in 50 pseudophakic eyes with moderate to advanced primary open-angle glaucoma(POAG).Methods:Fifty pseudophakic eyes underwent ab externo Preserflo Microshunt implantation.Data was gathered retrospectively and two groups were then created,group A with application of MMC 0.2 mg/ml and group B with MMC 0.2 mg/ml and Ologen collagen matrix(OCM)implantation.Absolute success was regarded as the percentage of eyes achieving:a)5≤intraocular pressure(IOP)≤13 mmHg,b)5≤IOP≤16 mmHg,and c)5≤IOP≤21 mmHg without additional medication or surgery and qualified success was regarded as the percentage of eyes achieving a)IOP≤13 mmHg,b)IOP≤16 mmHg,and c)IOP≤21 mmHg with or without medication.Evaluation was performed using a log-rank Kaplan-Meier test.A scatterplot analysis presented the treatment effect data of all eyes with a minimum of 20%IOP reduction per case.Failure was defined as requiring additional surgery,IOP greater than 21 mmHg with or without medication and failure to reach 20%IOP reduction.Results:Mean postoperative IOP was significantly lower in both groups.IOP decreased by 49.06%in group A and by 53.01%in group B at 6 months(P<0.88),respectively.Medication use was lower in both groups(Wilcoxon test,P<0.001).The absolute and qualified success rates were not statistically significant between the groups(all P>0.05).Cumulative IOP results per case were not statistically different in group A compared with group B.One revision surgery in group A(4%failure rate)and three in group B(12%failure rate)were performed.Conclusions:Both groups showed equal results in terms of cumulative and mean IOP reduction,medication reduction as well as in absolute and qualified success rates.No significant difference was found in any parameters tested between Preserflo Microshunt with MMC 0.2 mg/ml and with or without OCM implantation at 6 months.Long-term follow-up is required to further evaluate this data.