Trabeculectomy versus Canaloplasty (TVC study)

Finally, a head-to-head trial comparing the glaucoma surgeries trabeculectomy and canaloplasty [1]. And, the results heavily favor the safety of canaloplasty over trabeculectomy while also showing an impressive intraocular pressure reduction with canaloplasty. Even more noteworthy is a strong statement made by Dr. Kai Januschowski supporting canaloplasty over trabeculectomy as a “first line” surgical treatment. I am hopeful other glaucoma surgeons will heed this message.

This    changes    the    dynamics    of the   surgical approach   for treating glaucoma  patients:  It  makes  canaloplasty  the  first-line  surgical  strategy yielding the same IOP-lowering potential  with  less  severe  side-effects  than trabeculectomy   and   more attractive postoperative  strategies  if  target  IOP is not reached. Trabeculectomy will in our  eyes  remain  an  attractive second line  therapy  besides  deep  sclerectomy.

We  should  be   asking  ourselves   the question: which of the two equal IOP-lowering procedures is preferable – the one with 50% chance of having to use additional  topical  therapy  [canaloplasty] or  the  one with  a  25%  possibility  for  additional topical therapy  but with  high chances of severe intra- and postoperative complications and failure [trabeculectomy].

Dr. Kai Januschowski

UP NEXT: My thoughts on the recently published Trabeculectomy vs. Canaloplasty trial. Subscribe to our newsletter so you won’t miss it!

References
  1. Matlach J, Dhillon C, Hain J, Schlunck G, Grehn F, Klink T. Trabeculectomy versus canaloplasty (TVC study) in the treatment of patients with open-angle glaucoma: a prospective randomized clinical trial. Acta Ophthalmologica. 2015;93(8):753-761.[2] Januschowski K, Leers S, Haus A, Szurman P, Seuthe A, Boden K. Is trabeculectomy really superior to canaloplasty?. Acta Ophthalmologica. 2016;:n/a-n/a.

David Richardson, MD

Medical Director, San Marino Eye

David Richardson, MD 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. → Learn more about Dr. David Richardson

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