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Microinvasive Glaucoma Surgery: A Review of Schlemm’s Canal-Based Procedures

Authors Konopińska J, Lewczuk K, Jabłońska J, Mariak Z, Rękas M

Received 6 December 2020

Accepted for publication 18 February 2021

Published 11 March 2021 Volume 2021:15 Pages 1109—1118

DOI https://doi.org/10.2147/OPTH.S293702

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser


Supplementary video 1: "Ab-interno canaloplasty (ABiC)" [ID293702].

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Joanna Konopińska,1 Katarzyna Lewczuk,2 Joanna Jabłońska,2 Zofia Mariak,1 Marek Rękas2

1Department of Ophthalmology, Medical University of Bialystok, Białystok, Poland; 2Department of Ophthalmology, Military Institute of Medicine, Warsaw, Poland

Correspondence: Joanna Konopińska
Department of Ophthalmology, Medical University of Białystok, Jana Kilińskiego 1 STR, Białystok, 15-089, Poland
Tel +48 857468372
Fax +48 857468604
Email [email protected]

Abstract: Microinvasive glaucoma surgery has gained popularity over the past decade. It can be performed using three different mechanisms. In the present review, we focused on Schlemm’s canal (SC)-based surgery, which increases aqueous humor (AH) outflow into the aqueous veins by either removal of the trabecular meshwork (TM) or an increase in the tension in the TM. In primary open-angle glaucoma (POAG), the TM is the most likely region for increased AH outflow resistance. Theoretically, removal of the TM can improve the AH outflow; hence, glaucoma specialists focus on microsurgical dissection of the TM. In this review, we analyzed the available literature to examine SC-related microsurgical modalities based on the histopathological proofs of the localization of resistance of the AH outflow. First, we considered the role, anatomy, and physiology of the TM and SC. We referred to studies that describe the mechanisms and potential pathways, related to increased intraocular pressure in the POAG, that are targeted using the SC-related microsurgical interventions. Next, we took a closer look at the gonioscopic tools necessary for an ab-interno approach and explored incision canal surgery: ab-interno trabeculectomy using different instrumentation (Trabectome®, Kahook Dual Blade) and variations of the technique. Thereafter, we discussed ab-interno canaloplasty, explaining the technique and reviewing its effectiveness. Finally, we presented the scope for future research in the field. Although the iStent also targets SC by bypassing it, this device has been reviewed extensively elsewhere.

Keywords: microsurgery, trabecular meshwork, canaloplasty, trabeculotomy, Kahook Dual Blade, Schlemm’s canal

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