gms | German Medical Science

Purpose: This retrospective study aims to evaluate and compare the efficacy of two glaucoma surgical techniques – canaloplasty and canaloplasty with suprachoroidal drainage – in reducing intraocular pressure (IOP) and the need for postoperative glaucoma medication at various intervals up to 36 months after surgery.

Methods: Patients with glaucoma without previous glaucoma surgery were retrospectively included. The study involved three experienced surgeons who performed either canaloplasty or canaloplasty combined with suprachoroidal drainage, based on the clinical judgement of the consulting surgeons. Patients undergoing additional glaucoma surgery were excluded from the study, but those undergoing concomitant cataract surgery were included. Statistical analyses were performed using t-tests. 345 eyes were evaluated: 67 underwent canaloplasty and 278 received the combined procedure.

Results: Significant reductions in IOP and the number of IOP lowering medications required were observed in both groups at all time points. The combined procedure group showed a greater reduction in IOP from 9 months and required less medication from 6 months postoperatively, with no significant complications reported. At 36 months, the mean IOP reduction was greater in the combined group (baseline 23.18 ± 7.8 mmHg to 14.25 ± 3.35 mmHg) compared to the canaloplasty alone group (baseline 24.5 ± 10.74 mmHg to 14.91 ± 3.32 mmHg, p < 0.01). Medication use was significantly reduced in both groups, with the combined procedure showing a greater reduction.

Conclusions: Both canaloplasty and canaloplasty with suprachoroidal drainage effectively lower IOP and reduce the need for glaucoma medications after surgery. The addition of suprachoroidal drainage appears to provide a marginal benefit in both IOP reduction and medication requirements. These findings highlight the potential of canaloplasty with suprachoroidal drainage as a valuable surgical option in glaucoma management, potentially challenging the primacy of trabeculectomy. Further studies, ideally with randomised designs, are warranted to substantiate these findings and to explore the long-term implications for clinical practice.