Canaloplasty has been shown to be both an effective and safe surgical method of lowering intraocular pressure (IOP). However, there is still a widely held belief among gluacoma surgeons that canaloplasty is simply too challenging to bother with given that trabecuectomy (a much faster and easier surgery) may provide greater IOP lowering (albeit at higher risk). For many patients, however, trabeculectomy is just not a good long-term option.
[Photo Source: Canal Expander | Canal Expander [Internet]. Canalexpander.com. 2017 [cited 2017 Mar 18]. Available from: http://www.canalexpander.com]
The inventor of canaloplasty, Dr. Robert Stegmann, has devoted much of his life to saving the vision of patients in the South African “bush” who, unfortunately, do not do well with trabeculectomy. As such, he has found canaloplasty to be worthy of the additional effort in the operating room. Not one to rest on the success of “good enough,” Dr. Stegmann has been diligently working on ways to improve the IOP lowering benefit of canaloplasty. He now appears to have succeeded in this effort.
Traditional “Ab-Externo” canaloplasty involves the dilation of Schlemm’s canal followed by stenting it open with a suture. This suture keeps the canal open in the same way a string keeps the hood of a sweatshirt in place over one’s head: by tugging on the inside wall of the canal. Dr. Stegmann believed that if he could find a way to further expand the canal then canaloplasty could be even more effective at lowering the IOP in patients with glaucoma.
What he has invented is a tube-shaped scaffolding device, about twice the thickness of a human hair. It is placed into Schlemm’s canal after canaloplasty has been performed. Once inserted, the Stegmann Canal Expander® keeps up to half of the canal open – permanently.
In The Same Series:
- Canaloplasty with the Stegmann Canal Expander®
- How Well Does the Stegmann Canal Expander® Work?
- Risks of Canaloplasty with the Stegmann Canal Expander®
- Comparison to Canaloplasty without the Stegmann Canal Expander®
- Who Will Likely Benefit from the Stegmann Canal Expander®?
About the Author: David Richardson, MD
Medical Director, San Marino Eye
David Richardson, M.D. is widely recognized as one of the top cataract and glaucoma surgeons in the US and is among an elite group of glaucoma surgeons in the country performing the highly specialized canaloplasty procedure. Morever, Dr. Richardson is one of only a few surgeons in the greater Los Angeles area that performs Micropulse® "Cyclophotocoagulation" (MP3) glaucoma laser surgery. Dr. Richardson graduated Magna Cum Laude from University of Southern California and earned his Medical Degree from Harvard Medical School. He completed his ophthalmology residency at the LAC+USC Medical Center/ Doheny Institute. Dr. David Richardson is also an Adjunct Assistant Professor of Clinical Ophthalmology at Keck School of Medicine of USC. Twice weekly, he treats veterans at the VA Greater Los Angeles Veterans Healthcare System.