Skip to main content

Advertisement

SpringerLink
Log in

Can perforations of descemet’s window (DW) improve the outcome of canaloplasty in open angle glaucoma?

  • Glaucoma
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

This study evaluates whether additional opening of the descemet’s window (DW) in canaloplasty has a positive effect on the intraocular pressure (IOP), glaucoma medication, visual acuity and postoperative complications and further interventions within the subsequent 12 months. This study also compares the difference of myopia and non-myopia based on the respective surgical method, as well as the quality of life after surgery by means of a questionnaire.

Patients and methods

This retrospective study included 114 patients who had a complete ophthalmic examination at baseline, as well as the first post-operative day and at 1, 3, 6, and 12 months following the procedure. The patients were divided into three groups: group 1 with intact DW (n = 35), group 2 with accidental rupture of the DW (n = 40), and group 3 with scheduled puncture of the DW (n = 39). Main outcome parameters were IOP reduction and the number of IOP-lowering medications. Intraoperative and postoperative complications were documented systematically.

Results

With a follow-up period of 12 months, all three groups showed statistically significant reductions in mean IOP and number of glaucoma medications as compared with preoperative values. At 12 months, group 1 (group 2/3) had a mean IOP reduction of 27.3% (33.1%/36.3%) and medication use reduction of 75% (82.6%/91.7%). Comparing the three surgical groups, there was no significant difference in terms of reduction of IOP and medication (p > 0.05) at all time points. Surgical complications were similarly rare. The number of subconjunctival blebs was statistically significantly different in the three groups (p < 0.05; group 1, 0%; group 2, 15%; group 3, 12.8%). Only in group 1, a revision after surgery was necessary in three cases. A significant difference concerning IOP, medication use, and visual acuity was not found between myopic eyes and non-myopic eyes after canaloplasty. The postop-surgical questionnaire showed that with 90.5% in group 1, 88.5% in group 2, and with 90.5% in group 3, the patients were highly satisfied with the results of surgery.

Conclusion

The intraoperative scheduled puncture of the DW in tendency showed better but no statistically significant results after 1 year regarding lowering of the IOP, the visual acuity, and postoperative medication usage. In addition, no increased risk of complications was observed in the myopic eye after the opening of the DW.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Johnstone MA, Grant WM (1973) Microsurgery of Schlemm’s canal and the human aqueous outflow system. Am J Ophthalmol 76(6):906–917

    Article  CAS  PubMed  Google Scholar 

  2. Yalvac IS, Sahin M, Eksioglu U, Midillioglu IK, Aslan BS, Duman S (2004) Primary viscocanalostomy versus trabeculectomy for primary open-angle glaucoma. J Cataract Refract Surg 30(10):2050–2057

    Article  PubMed  Google Scholar 

  3. Carassa RG (2011) Comparing Viscocanalostomy with trabeculectomy. US Ophthalmic Rev 04(02):88

    Article  Google Scholar 

  4. Schild A, Jordan J, Konen W, Krieglstein G, Dietlein T (2008) Patientenzufriedenheit nach filtrierender Glaukomchirurgie mit Mitomycin C. Klin Monbl Augenheilkd 225(2):155–158

    Article  CAS  PubMed  Google Scholar 

  5. Ayyala RS, Chaudhry AL, Okogbaa CB, Zurakowski D (2011) Comparison of surgical outcomes between Canaloplasty and trabeculectomy at 12 months’ follow-up. Ophthalmology 118(12):2427–2433

    Article  Google Scholar 

  6. Gesser C, Matthaei M, Meyer-Rüsenberg MB, Richard G, Klemm M (2012) Einfluss einer Kataraktoperation auf die drucksenkende Wirkung einer Kanaloplastik. Der Ophthalmol 109(8):770–776

    Article  CAS  Google Scholar 

  7. Seuthe AM, Januschowski K, Szurman P (2016) Micro-invasive 360-degree suture trabeculotomy after successful canaloplasty – one year results, Graefe’s Arch. Clin Exp Ophthalmol 254(1):155–159

    Article  Google Scholar 

  8. Koerber NJ (2011) Canaloplasty in one eye compared with Viscocanalostomy in the contralateral eye in patients with bilateral open-angle Glaucoma. J Glaucoma 21(2):1

    Article  Google Scholar 

  9. Lewis RA u a (2009) Canaloplasty: circumferential viscodilation and tensioning of Schlemm canal using a flexible microcatheter for the treatment of open-angle glaucoma in adults. J Cataract Refract Surg 35(5):814–824

    Article  PubMed  Google Scholar 

  10. Lewis RA u a (2009) Canaloplasty: three-year results of circumferential viscodilation and tensioning of Schlemm canal using a microcatheter to treat open-angle glaucoma. J Cataract Refract Surg 37(4):682–690

    Article  Google Scholar 

  11. Grieshaber MC, Schoetzau A, Flammer J, Orgül S (2013) Postoperative microhyphema as a positive prognostic indicator in canaloplasty. Acta Ophthalmol 91(2):151–156

    Article  CAS  PubMed  Google Scholar 

  12. Koch J, Heiligenhaus A, Heinz C (2011) Kanaloplastie und transiente Vorderkammerblutung: ein prognostischer Faktor? Klin Monbl Augenheilkd 228(05):465–467

    Article  CAS  PubMed  Google Scholar 

  13. Cagini C, Peruzzi C, Fiore T, Spadea L, Lippera M, Lippera S (2016) Canaloplasty: current value in the management of Glaucoma. J Ophthalmol 2016:1–6

    Article  CAS  Google Scholar 

  14. Brusini P (2014) Canaloplasty in open-angle glaucoma surgery: a four-year follow-up. ScientificWorldJournal. 2014:469609

    Article  PubMed  PubMed Central  Google Scholar 

  15. Harvey BJ, Khaimi MA (2011) A review of canaloplasty. Saudi J Ophthalmol Off J Saudi Ophthalmol Soc 25(4):329–336

    Article  Google Scholar 

  16. Lewis RA u a (2007) Canaloplasty: Circumferential viscodilation and tensioning of Schlemm’s canal using a flexible microcatheter for the treatment of open-angle glaucoma in adults. J Cataract Refract Surg 33(7):1217–1226

    Article  PubMed  Google Scholar 

  17. Thomas M, Vajaranant TS, Aref AA (2015) Hypotony Maculopathy: Clinical Presentation and Therapeutic Methods. Ophthalmol Ther 4(2):79

    Article  PubMed  PubMed Central  Google Scholar 

  18. Fannin LA, Schiffman JC, Budenz DL (2003) Risk factors for hypotony maculopathy. Ophthalmology 110(6):1185–1191

    Article  PubMed  Google Scholar 

  19. McBrien NA, Cornell LM, Gentle A (2001) Structural and ultrastructural changes to the sclera in a mammalian model of high myopia. Invest Ophthalmol Vis Sci 42(10):2179–2187

    CAS  Google Scholar 

  20. Dietze PJ, Oram O, Kohnen T, Feldman RM, Koch DD, Gross RL (1997) visual function following trabeculectomy: effect on corneal topography and contrast sensitivity. J Glaucoma 6(2):99–103

    Article  CAS  PubMed  Google Scholar 

  21. Hirooka K, Nitta E, Ukegawa K, Tsujikawa A (2017) Vision-related quality of life following glaucoma filtration surgery. BMC Ophthalmol 17(1):66

    Article  PubMed  PubMed Central  Google Scholar 

  22. DG DSW, Sharpe ED, Atkinson MJ, Stewart JA (2006) The clinical validity of the treatment satisfaction survey for intraocular pressure in ocular hypertensive and glaucoma patients. Eye (Lond) 20(5):583–590

    Article  Google Scholar 

Download references

Funding

No funding was received for this research.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, University of Köln, Kerpener Str. 62, 50937, Köln, Germany

    Barbara Pullig & Thomas Dietlein

  2. Augencentrum Köln-Porz, Josefstr. 14, 51143, Köln, Germany

    Norbert Josef Koerber

Authors
  1. Barbara Pullig
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Norbert Josef Koerber
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas Dietlein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Barbara Pullig.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional 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.

Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights and informed consent

This article does not contain any studies with animals performed by any of the authors.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pullig, B., Koerber, N.J. & Dietlein, T. Can perforations of descemet’s window (DW) improve the outcome of canaloplasty in open angle glaucoma?. Graefes Arch Clin Exp Ophthalmol 257, 1733–1740 (2019). https://doi.org/10.1007/s00417-019-04340-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-019-04340-z

Keywords

Search

Navigation