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Flap-sparing canaloplasty: a modified approach to Schlemm’s canal

  • Glaucoma
  • Published:
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Abstract

Purpose

To present a modified surgical technique for canaloplasty with the Stegmann Canal Expander obviating the need for lamellar scleral dissection.

Methods

After limbal peritomy of the conjunctiva, the sclera is not dissected in the classic lamellar fashion with superficial and deep scleral flaps but is successively ‘scratched’ down by radial incision until Schlemm’s canal (SC) is opened (trench cut). Following canal opening and viscodilation with a microcannula and sodium hyaluronidate, one Stegmann Canal Expander is implanted on either side of the canal ostia and the scleral incision is closed watertight.

Results

Twenty-seven eyes with primary open-angle glaucoma (POAG) were consecutively operated on using this modified technique. In all eyes, SC was successively opened, but exposure of the choroid and rupture of trabeculo-Descemet’s membrane with iris prolapse or filtering blebs were not found. Adverse events included trimming of the expander in one eye for incomplete implantation during surgery, and transient microhyphaema in five eyes post-surgery. Mean intraocular pressure (IOP) was 31.9 mmHg ± 6.0 (SD) before surgery and 14.0 mmHg ± 2.5 (SD) 6 months and 15.2 mmHg ± 1.95 (SD) 12 months after surgery.

Conclusions

The flap-sparing, trench-cut incision technique may reduce the risk of complications in canaloplasty with the Stegmann Canal Expander while effectively lowering IOP in POAG patients.

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Author information

Authors and Affiliations

  1. Department of Ophthalmology, Sefako Makgatho Health Sciences University (formerly Medical University of Southern Africa), Medunsa, Pretoria, South Africa

    Matthias C. Grieshaber, Ané Pienaar & Robert Stegmann

  2. Department of Ophthalmology, University of Basel, Mittlere Strasse 91, CH-4031, Basel, Switzerland

    Matthias C. Grieshaber

Authors
  1. Matthias C. Grieshaber
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  2. Ané Pienaar
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  3. Robert Stegmann
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Corresponding author

Correspondence to Matthias C. Grieshaber.

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Conflict of interest

Author RS has received research grants from Ophthalmos GmbH. Author RS and MCG have intellectual property rights (patents). Author AP declares that she has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Grieshaber, M.C., Pienaar, A. & Stegmann, R. Flap-sparing canaloplasty: a modified approach to Schlemm’s canal. Graefes Arch Clin Exp Ophthalmol 257, 1729–1732 (2019). https://doi.org/10.1007/s00417-019-04329-8

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  • DOI: https://doi.org/10.1007/s00417-019-04329-8

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