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Middle East African Journal of Ophthalmology Middle East African Journal of Ophthalmology
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GLAUCOMA SURGERY UPDATE
Year : 2015  |  Volume : 22  |  Issue : 1  |  Page : 38-44

Update on Schlemm's canal based procedures


1 Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland; Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
2 Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland

Correspondence Address:
Kaweh Mansouri
Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-9233.148347

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Surgical options for glaucoma have expanded in recent years. This article provides an evidence-based update on the novel or emerging surgical techniques for the treatment of open-angle glaucoma that are based on the Schlemm's canal (SC). Canaloplasty is an ab externo approach and was developed as an alternative to traditional filtering surgeries. The Hydrus microstent (Ivantis Inc., Irvine, CA) is a so-called SC scaffold that directly bypasses the trabecular meshwork to drain aqueous humor into the SC, which it keeps dilated over approximately one quadrant. Canaloplasty has also been shown to lower intraocular pressure (IOP) by up to 40% and combined with cataract surgery. IOP was lowered 44% at 24 months while maintaining a favorable safety profile. The Hydrus device has been proposed as an adjunct to cataract extraction surgery. To date, no published evidence from clinical trials is available on its in vivo safety and efficacy. Schlemm's canal based glaucoma procedures show promise as alternative treatments to traditional glaucoma surgery. Surgeons must be comfortable with angle anatomy. A prerequisite for functionality of these techniques is the integrity of the distal outflow system. At present, however, it is not possible to conclude whether these novel procedures will be viable alternatives to standard filtering surgery over the long-term.


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