Canaloplasty versus Trabeculectomy
Trabeculectomy (with use of Mitomycin-C, or “MMC”) is considered by many eye surgeons to be the “gold standard” of glaucoma surgery. It is historically preferred for surgical management of glaucoma when drops and laser treatments have failed. Although the most common method of surgical treatment, it is far from risk-free which is why new treatments for glaucoma are continuously being developed. The ultimate glaucoma treatment would be safer than trabeculectomy, but just as effective. How does Canaloplasty compare to trabeculectomy? Following is a list of risks and benefits of both surgeries as documented in clinical studies that have either been published in the medical literature or presented at professional meetings of eye surgeons. References used to support the statements made in this comparison can be viewed by hovering/clicking the hyperlinks within the text below:
| Does it Work? | Canaloplasty | Trabeculectomy + MMC |
| One Year (after surgery) Results[1] | ||
| Average IOP (intraocular pressure) | 13.4mmHg | 12.3mmHg[2] |
| Number of medications needed | 0.6 | 0.7[3] |
| Loss of Vision |  2% |
16% |
| Long-Term Risks | ||
| Hypotony Maculopathy (with likely vision loss) | <1%[4] |
Up to 20%[5] |
| Chronic irritation from Bleb | No |
Yes[6] |
| Bleb leak | No |
4% per year[7] |
| Vision-threatening Eye Infection | No |
Yes[8] |
| Cataract Formation | MINIMAL |
Yes (78% at 5 years)[9] |
| Lifestyle Issues | ||
| Able to enjoy watersports |  Yes |
 No[a] |
| Able to wear soft contact lenses | Yes |
No[b] |
Who is a Good Candidate?
Patients with Common Open Angle GlaucomaYesYesYounger patientsYesNo[c]High myopesYesNo[10][d]Black patients with open angle glaucomaYes[11]No[e]Patients with “end-stage” glaucomaNoPossibly[f]
In summary, for those who are candidates for Canaloplasty, it offers greater safety over trabeculectomy with similar benefits.
Perhaps no table can sum up the key reason to consider Canaloplasty over Trabeculectomy better than the following quote by the respected surgeon, Dr. Thomas Samuelson. Regarding trabeculectomy:
“It would not be rare to have a patient do beautifully for 5 years … and then all of a sudden, a severe bleb-related infection could threaten eyesight. That could happen anytime in the lifetime of that bleb, 5 years later, 10 years later…There are very few surgeries that subject patients to unending, serious risk.[12]”
If you are considering glaucoma surgery, no doubt you are looking for a way to preserve your vision. Why, then, would you choose a surgery that subjects you to “unending, serious risk” when options such as Canaloplasty exist?
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