Canaloplasty with mitomycin C after previous combined cataract surgery and Schlemm's canal microstent implantation

We report on a 56-year-old male with primary open-angle glaucoma who underwent mitomycin C augmented canaloplasty enabling filtration in the right eye after cataract surgery combined with a Schlemm's canal microstent 3 years previously. He showed progressive glaucomatous optic neuropathy and was highly myopic (axial length 32.05 mm, spherical equivalent -18.75 dioptres in the right eye). Augmented canaloplasty was performed uneventfully and 360° catheterisation was achieved followed by the placement of a 10-0 polypropylene suture in Schlemm's canal. Intraocular pressure (IOP) in the first post-operative day was reduced from 19 to 6 mmHg. At 1-month follow-up IOP was 12 mmHg off glaucoma medications. The presence of a minimally invasive glaucoma surgery (MIGS) device did not hinder successful catheterisation of Schlemm's canal. Significant reduction of IOP was obtained in the early post-surgical period. No intra-operative complications were registered and only transient hyphema in early post-operative period was reported. This augmented canaloplasty could be an effective alternative to trabeculectomy even after Schlemm's canal microstent implantation.