Is Trabeculectomy an Option After Canaloplasty?

Is Trabeculectomy an Option after Canaloplasty? One of the common misconceptions about Canaloplasty is that it eliminates the future option a Trabeculectomy . It’s also, sadly, one of the more common reasons patients chose not to have Canaloplasty when their glaucoma is severe enough that it requires surgical treatment. Surgeons who do not perform (or only infrequently perform) Canaloplasty may have the impression that trabeculectomy cannot be performed after Canaloplasty. Why would this be so? Well, as a general rule, once you have had surgery on the conjunctiva it is technically more challenging to perform trabeculectomy due to the scarring from prior surgery. Even if the surgery can be successfully performed, trabeculectomies after prior eye surgery are more likely to fail. As Canaloplasty is performed by creating a conjunctival flap in the area of the eye commonly used for other glaucoma surgeries, it’s reasonable for surgeons who have little experience with Canaloplasty to assume that trabeculectomy would also be difficult or prone to failure after Canaloplasty.

Experienced Canaloplasty surgeons, however, have been aware for years that the conjunctiva in the area of prior Canaloplasty has a very normal appearance with minimal scarring. This is very different than the expected conjunctival scarring seen after other glaucoma, retinal or older style cataract surgeries. Among experienced Canaloplasty surgeons it has also been accepted that Canalolplasty does not limit a skilled surgeon’s ability to perform either a trabeculectomy or placement of a tube implant (Ahmed, Baerveldt, or Molteno) in the area of prior Canaloplasty surgery. Unfortunately, this was considered hearsay by most glaucoma surgeons with little or no experience with Canaloplasty.

About the Author: David Richardson, MD

Medical Director, San Marino Eye

David Richardson MD - Top Glaucoma SurgeonDavid 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.

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