PhacoCanaloplasty™ vs Phacotrab

Canaloplasty Is as Effective as Trabeculectomy When Combined with Cataract Surgery

Unlike with trabeculectomy, cataract surgery enhances the IOP lowering effect of canaloplasty.[1] A recent study comparing the results of combined cataract and glaucoma surgery (”phaco­trabeculectomy” vs. “phaco­canaloplasty”) was published in the Journal of Glaucoma.[2] One year after surgery, participants who underwent phaco­canaloplasty had IOPs that were not significantly higher than those who underwent phaco-trabeculectomy. The median percent reduction in IOP was greater after phaco-trabeculectomy (40%) versus phaco­canaloplasty (28%). However, this may have been due to higher initial IOP in the phaco­trabeculectomy group.

Final glaucoma medication use as well as failure rate was similar in both groups. Over 60% of study patients in both groups were off all glaucoma drops one year after surgery. Although final vision was similar in both groups, those who underwent phaco­canaloplasty experienced faster improvement of vision compared to those who underwent phaco-trabeculectomy glaucoma surgery.

No patients in the phaco­canaloplasty group experienced the feared complications of hypotony or associated loss of vision from hypotony maculopathy. Indeed, the authors of the study go on to state that, “We have seen neither hypotony maculopathy nor suprachoroidal effusions/hemorrhage so far after canaloplasty in our experience. This is a distinct advantage of the canal­based surgery as also is the absence of a bleb and bleb-related problems such as infections and discomfort.”

References
  1. Lewis RA, von Wolff K, Tetz M, et al. Canaloplasty: three­year results of circumferential viscodilation and tensioning of Schlemm canal using a microcatheter to treat open­angle glaucoma. J Cat Ref Surg. 2011;37(4):682­690.
  2. Schoenberg ED, Chaudhry AL, Chod R, Zurakowski D, Ayyala RS. Comparison of Surgical Outcomes Between Phacocanaloplasty and Phacotrabeculectomy at 12 Months’ Follow­up: A Longitudinal Cohort Study. J Glaucoma. 2015;24(7):543­549.

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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