After a decade of traditional canaloplasty procedures, I have accumulated probably more data on the intervention than any other US surgeon. Ab externo canaloplasty is an intricate operation, comprising probe insertion into Schlemm’s canal; attachment of a prolene suture to the probe; probe retraction with viscodilation; and suture ligation to maintain canal patency. Some traditional canaloplasty patients, however, get viscodilation without suturing – and, when I reviewed my data, I saw that these patients had excellent three-year outcomes. This revelation suggested that the ab externo suture approach was unnecessary – and that’s how I came to be involved in the genesis and subsequent development of ABiC. I had tremendous confidence in ABiC from the start; having employed traditional canaloplasty for years, I knew that treating the drainage system gives excellent results. Traditional glaucoma surgery such as trabeculectomy and glaucoma drainage devices are associated with sight-threatening risks; MIGS procedures are safer, but most of them are little better than a crapshoot, because surgeons cannot know the location of the blockage. From a theoretical standpoint, ABiC makes far more sense, as it safely rejuvenates the entire natural out-flow system. With hindsight, the advantages are obvious. Absent a diagnostic that identifies the site of outflow blockage, why not treat the whole outflow system? Indeed, doing so addresses all drainage problems, regardless of their precise location – whether in trabecular meshwork (TM), Schlemm’s or collector channels.
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Authors
Mahmoud Khaimi Mahmoud Khaimi is a Clinical Associate Professor at the Dean McGee Eye Institute/University of Oklahoma in Oklahoma City, USA. He is recognized as a world authority on canal based surgery and has given numerous national and international lectures. Norbert Koerber Norbert Koerber specializes in cataract and glaucoma surgery, and runs a group practice and an outpatient surgery center in Cologne, Germany. He has published over 150 publications and presentations in the field of cataract, refractive and glaucoma surgery. Mark Gallardo Mark Gallardo is an ophthalmologist and glaucoma specialist. He has worked in ophthalmology for nearly 20 years, and currently is affiliated with Hospitals of Providence Sierra Campus, Las Palmas Medical Centre and University Medical Center of El Paso, Texas, USA. Savak Teymoorian Sev Teymoorian is a board certified ophthalmologist, and a cataract and glaucoma specialist at Harvard Eye Associates, Laguna Hills, California, USA. Leon Au Leon Au is a consultant glaucoma specialist at the Manchester Royal Eye Hospital, UK. He is an international leader in innovative MIGS and conducts clinical trials with these new procedures.
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