Tackling Tiny TMs

Accounting for eight percent of blindness among the pediatric population, childhood glaucoma (CG) remains a serious and threatening disease. Although trabeculotomy and goniotomy are effective at restoring healthy outflow, they often cause extensive structural damage to the anterior angle, risking complications, such as hyphema, cyclodialysis and hypotony.

In search of alternative treatment options for CG, researchers explored the outcomes and complications of penetrating canaloplasty in a new study published in the Journal of Glaucoma (1). Aiming to maintain the established efficacy of current goniosurgeries whilst improving their safety, the team was hopeful that penetrating canaloplasty would fit the bill.

The prospective consecutive case series study involved 32 participants suffering from CG between 2017 and 2020. Using a microcatheter to achieve a 360 º cannulation of Schlemm's canal, a tension suture was left in place and thus provided an inward distension. Postoperatively, the patients were treated with levofloxacin and dexamethasone eye drops four times daily for two weeks.

In contrast to surgeries that require the removal of a large portion of the trabecular meshwork, the small trabecular meshwork fistula used in penetrating canaloplasty allows the restoration of aqueous humor outflow whilst ensuring that the majority of the trabecular meshwork remains intact. In addition to being significantly less damaging than other angle surgeries, the study showed that results of penetrating canaloplasty are comparable to conventional trabeculotomy and current minimally invasive goniosurgeries. With complete and qualified success rates presenting in 81.1 percent of eyes and 89.2 percent of all eyes, respectively, at the 12-month follow-up, it is clear that penetrating canaloplasty offers a promising pathway for the future of CG management.