Role of Canaloplasty After Failed Glaucoma Procedures
Purpose
The role of canaloplasty has been relegated to primary glaucoma procedures in the past. This study sought to evaluate whether canaloplasty could be performed in cases failing previous surgery and if a retentive stent was essential for a successful outcome.
Methods
A retrospective review of 23 consecutive patients, average age 65.5 years, 60.9% female undergoing canaloplasty from April 2012 was conducted. All patients failed previous surgeries including ALT, SLT, Trabeculectomy w/Mitomycin and aqueous shunting alone or in various combinations. Parameters monitored measured included VA, IOP, visual field, nerve fiber layer analysis, and number of medications which were compared with and without stent. The relationship between the change in number of medications and improvement of IOP was also explored using correlation analysis.
Results
Retentive stent was used in 55.6% eyes. Both groups demonstrated significant reduction in number of medications,with or without stents, mean reduction (standard deviation) 1.3 (1.7) (p-value = 0.024) and 1.7 (0.8) (p-value < 0.001), respectively. Significant IOP improvement was observed in stent group: mean (standard deviation) 4.8 (5.7) (p-value = 0.013). None of the outcomes evaluated were found to be statistically different between these two groups. Improvement of IOP and medication reduction indicates a negative correlation (Spearman's rho = -0.553) for non-stent group, whereas the correlation was positive (Spearman's rho = 0.123) for stent group, although not statistically significant.
Conclusion
Canaloplasty appears to represent a viable option for control of glaucoma, despite previous failed glaucoma surgeries, therefore expanding treatment paradigm options. All parameters measured showed improvements in both groups. Larger clinical trials are needed to further investigate stent's value in this setting.