Multicentre study comparing ab-interno canaloplasty and trabecular micro-bypass stent in primary open-angle glaucoma

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Minimally Invasive Glaucoma Surgery (MIGS)

Background:

• Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness.
• Effective intraocular pressure (IOP) management is crucial for preventing glaucoma progression.
• Surgical interventions are increasingly utilized for POAG management when medical therapy is insufficient.

Purpose of the Study:

• To compare the clinical outcomes of iTrack ab-interno canaloplasty and iStent trabecular micro-bypass implantation in patients with mild-to-moderate POAG.
• To evaluate differences in intraocular pressure (IOP) reduction, medication usage, and surgical success rates between the two surgical techniques.
• To assess the safety profiles and complication rates associated with each procedure.

Main Methods:

• An ambispective study utilizing data from the International Glaucoma Surgery Registry (IGSR).
• Inclusion of patients with mild-to-moderate POAG who underwent either iTrack canaloplasty (prospective) or iStent implantation (retrospective).
• Analysis of primary outcomes including IOP, medication use, and surgical success (defined by AAO guidelines) with a minimum follow-up of 12 months.

Main Results:

• Both iStent and iTrack groups showed significant IOP and medication reduction (p<0.001).
• No statistically significant differences were observed in IOP reduction (p=0.422) or medication reduction (p=0.211) between the groups.
• A higher percentage of patients in the iTrack canaloplasty group became medication-free (42% vs. 29%, p=0.029).
• Surgical success rates were comparable (61% in both groups, p=1.000), with infrequent and self-limited complications in both cohorts.

Conclusions:

• iTrack canaloplasty and iStent implantation demonstrate comparable effectiveness in managing mild-to-moderate POAG.
• Both surgical procedures exhibit favorable safety profiles with low rates of complications and reoperations.
• Canaloplasty may offer an advantage in achieving a medication-free status for a greater proportion of POAG patients.