Update on Schlemm's canal based procedures

Area of Science:

• Ophthalmology
• Surgical Innovation
• Glaucoma Treatment

Background:

• Glaucoma surgical options have recently expanded.
• Novel techniques focus on Schlemm's canal (SC) for open-angle glaucoma.
• Traditional filtering surgeries have limitations.

Purpose of the Study:

• To provide an evidence-based update on emerging SC-based surgical techniques for open-angle glaucoma.
• To review the safety and efficacy of canaloplasty and the Hydrus microstent.
• To assess the potential of SC-based procedures as alternatives to conventional glaucoma surgery.

Main Methods:

• Review of evidence-based updates on novel surgical techniques.
• Focus on ab externo approaches like canaloplasty.
• Evaluation of SC scaffolds such as the Hydrus microstent.

Main Results:

• Canaloplasty lowers intraocular pressure (IOP) by up to 40%, especially when combined with cataract surgery (44% at 24 months).
• The Hydrus microstent aims to dilate SC and bypass the trabecular meshwork.
• Limited clinical trial data exists for the in vivo safety and efficacy of the Hydrus device.

Conclusions:

• SC-based glaucoma procedures demonstrate potential as alternatives to traditional surgery.
• Surgeon familiarity with angle anatomy and distal outflow system integrity are crucial for success.
• Long-term viability of these novel procedures compared to standard filtering surgery requires further investigation.