Interventional procedure overview of ab interno canaloplasty for open-angle glaucoma

Indications and current treatment

Glaucoma is usually a chronic condition that is typically associated with raised intraocular pressure (IOP). The most common type of glaucoma in the UK is primary open-angle glaucoma. It leads to progressive damage to the optic nerve. Early stages are usually asymptomatic. But, as the condition progresses, it causes visual impairment and, if untreated, blindness.

In the healthy eye, aqueous humor drains through the trabecular meshwork (into Schlemm's canal) and through the uveoscleral outflow pathway. In glaucoma, this drainage becomes impaired either via resistance in the trabecular meshwork pathway (primary open-angle glaucoma) or via obstruction by the iris (primary closed-angle glaucoma).

Treatment usually involves eye drops containing medicines that either reduce the production of aqueous humor or increase its drainage. Surgical procedures such as trabeculectomy, deep sclerectomy, trabeculotomy, stenting, canaloplasty, or laser trabeculoplasty may be used.

What the procedure involves

Ab interno canaloplasty aims to reduce IOP by improving the drainage of aqueous fluid from the eye in people with open-angle glaucoma. It is done under local or general anaesthetic. Unlike traditional (ab externo) canaloplasty, which is done by cutting through the conjunctiva and sclera, ab interno canaloplasty uses an internal approach via a clear corneal or limbal incision. A microcatheter is introduced into the canal through a small opening in the trabecular meshwork and advanced around its entire circumference. As the catheter tip is withdrawn, viscoelastic fluid is injected into the canal to dilate it. The microcatheter is then removed. The viscoelastic fluid disperses down the collector channels of the eye within 2 to 3 days. The aim is to permanently dilate the canal to allow increased drainage of aqueous humor from the eye and thereby lower IOP. Some devices allow canaloplasty to be done simultaneously with trabeculotomy. Canaloplasty is often done concurrently with phacoemulsification (cataract surgery).