Short- and Mid-Term Results of Schlemm Canal Dilation Using Novel Stainless-Steel Spiral Intracanalicular Device to Treat Open-Angle Glaucoma
Narrative Responses:
Purpose
Clinical evaluation of the efficacy of a novel stainless steel spiral intracanalicular device (ICD) in decreasing intraocular pressure (IOP) in patients with open-angle glaucoma (OAG).
Methods
This is a prospective, non-randomised, interventional case series of 18 glaucoma patients (18 eyes), who had implantation of an ICD in Schlemm’s canal (SC). Surgically device was implanted ab-externo after exposing and dilating SC with viscoelastic. Out of these, eight eyes (44.4%) underwent combined surgery. Two cases had previous glaucoma surgery. Outcome measures were IOP, number of medications and complications. Decrease in IOP >25% or IOP 18 mmHg or less without medication was considered as a complete success, with medication – partial success. A paired t-test was used for analysis. Results were considered significant when p<0.05. Minimum follow-up: 3 months.
Results
Mean baseline IOP (25.2mmHg) dropped to 12.6mmHg and 10.7mmHg (p=0.00004) accounting for reduction in IOP by 50 and 57.5% at 3 months (n=18) and 6 months (n=10) respectively. Mean number of medications reduced from 2.8 to 0.9 and 1.0 respectively. Complete success was observed in 11 and 6 cases, partial – in 7 and 4 cases. Intra-operatively micro-perforation of trabecular meshwork of unexposed SC occurred in 3 cases. Postoperatively transitory increase in IOP was noticed in 3 cases. One case required YAG laser goniopuncture. Gonioscopically, ICD was located in SC in 17 cases without any sign of inflammation.
Conclusion
Short- and midterm results of ICD insertion in management of OAG showed significant reduction in IOP from the baseline and there was significant reduction in glaucoma medication(s). Randomized, controlled and comparative studies with longer follow-up and larger groups are required in order to confirm the efficacy of this technique.