Modified Canaloplasty: A New, Effective, and Safe Option for Glaucoma Patients With a Disrupted Schlemm Canal Wall

Purpose: We describe a modified canaloplasty technique and report the short-term efficacy for primary open-angle glaucoma (POAG) patients with disruption of Schlemm canal (SC) wall resulting from prior glaucoma surgery. Patients and Methods: This was a single-surgeon prospective cohort study. POAG patients scheduled for canaloplasty were included and divided into 2 groups: group1 included POAG patients without a history of glaucoma surgery and group 2 included POAG patients with failed glaucoma surgery and disrupted SC. The status of SC was determined by gonioscopy and ultrasound biomicroscopy. Standard canaloplasty procedures were performed in group 1. A modified canaloplasty technique was used in group 2. Primary outcome measures included the intraocular pressure and glaucoma medication use at various follow-up points. Results: Seventeen patients were enrolled in group 1 and 9 patients were enrolled in group 2. At the 12-month follow-up, there was no significant difference between groups 1 and 2 (17.8 +/- 2.7 vs. 16.7 +/- 2.4mm Hg, respectively; P = 0.362) and in the mean number of medications (0.9 +/- 1.2 vs. 0.3 +/- 0.5, respectively; P = 0.061). In both groups, at all follow-up points, the intraocular pressure and the mean glaucoma medication usage had decreased significantly compared with measurements at baseline (P < 0.001). The rate for successful circumferential catheterization was not significant between the 2 groups (88.2% vs. 77.8%, P = 0.063). Conclusion: Modified canaloplasty is a feasible, safe, and potentially effective option for patients with POAG and regions of SC disruption resulting from previous glaucoma-filtering surgery.