Canaloplasty with Stegmann Canal Expander for primary open-angle glaucoma: two-year clinical results.
Grieshaber Matthias C, Schoetzau Andreas, Grieshaber Hans R, Stegmann Robert
AI Summary
Canaloplasty with the Stegmann Canal Expander effectively lowered IOP and reduced medication use for two years in POAG patients, demonstrating a safe and lasting treatment option.
Abstract
Purpose
To examine longer-term postsurgical safety and efficacy of a new expander for Schlemm's canal.
Methods
In a non-comparative, prospective study, 42 White patients with medically uncontrolled primary open-angle glaucoma (POAG) underwent primary canaloplasty with >2-year follow-up. The bleb-independent procedure comprised catheter-assisted canaloplasty and implantation of two Stegmann Canal Expanders to maintain trabecular distension and canal patency over 180°. Intraocular pressure (IOP), glaucoma medication use and complications were assessed.
Results
Mean IOP was 26.8 ± 5.6 mmHg presurgery, 12.8 ± 1.5 mmHg at 6 months, 13.2 ± 1.2 mmHg at 12 months and 13.3 ± 2.5 mmHg at 24 months (p < 0.001). Rate of complete success, defined as IOP ≤21, ≤18 and ≤16 mmHg and a ≥ 30% IOP reduction, was 85% (95% CI: 0.76-0.95), 85% (0.76-0.95) and 82% (0.70-0.96) at 12 months and 83% (0.73-0.94), 80% (0.70-0.92) and 80% (0.70-0.92) at 24 months. Preoperative factors were not significant predictors of ≤16 mmHg IOP reduction: IOP (hazard ratio [HR]: 0.68; 95% CI: 0.44-1.04; p = 0.08), mean visual defect (1.06; 0.90-1.20; p = 0.47), number of medications (0.59; 0.17-2.14; p = 0.42) and age (0.96; 0.87-1.13; p = 0.41). Number of medications dropped from 2.8 ± 0.4 presurgery to 0.2 ± 0.5 postsurgery (p < 0.001). Mean preoperative best-corrected visual acuity was 0.19 ± SD 0.21 (range: 0-1.6), and logMAR was similar to 0.23 ± 0.16 (range: 0-1.6; p = 0.42) after a mean follow-up of 27.4 months. Complications included peripheral Descemet's membrane detachment (7.2%) and trimming of the expander (4.7%) during surgery, and transient microhyphaema (23.8%) and IOP elevation (7.2%) postsurgery.
Conclusion
Canaloplasty with the Stegmann Canal Expander was a safe and effective procedure to reduce IOP in White patients with moderate to advanced POAG.
MeSH Terms
Shields Classification
Key Concepts4
Canaloplasty with the Stegmann Canal Expander reduced mean intraocular pressure (IOP) from 26.8 5.6 mmHg presurgery to 13.3 2.5 mmHg at 24 months (p < 0.001) in 42 White patients with medically uncontrolled primary open-angle glaucoma (POAG).
The rate of complete success, defined as IOP ≤16 mmHg and a ≥ 30% IOP reduction, for Canaloplasty with the Stegmann Canal Expander was 80% (95% CI: 0.70-0.92) at 24 months in 42 White patients with medically uncontrolled primary open-angle glaucoma (POAG).
The number of glaucoma medications dropped from 2.8 0.4 presurgery to 0.2 0.5 postsurgery (p < 0.001) after Canaloplasty with the Stegmann Canal Expander in 42 White patients with medically uncontrolled primary open-angle glaucoma (POAG).
Complications of Canaloplasty with the Stegmann Canal Expander included peripheral Descemet's membrane detachment (7.2%) and trimming of the expander (4.7%) during surgery, and transient microhyphaema (23.8%) and IOP elevation (7.2%) postsurgery in 42 White patients with medically uncontrolled primary open-angle glaucoma (POAG).
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