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Trabeculectomy

Is It True That Both Trab W/ EX-Press and Trab Alone Have More Potential to Achieve a Lower Pressure than a Canaloplasty?

ANSWER:

Dear ******,

In general that is true if Mitomycin-C (MMC) is used. However, that extra IOP lowering comes at a cost and I’m not talking about dollars. The price is paid in risk: risk of loss of vision, hypotony with associated maculopathy, lifetime (of the bleb) risk of infection, increased ocular surface disease (dry eye irritation), etc. There is at least one study, however, that showed no difference between the average IOP reduction from Trab+MMC and Canaloplasty. This study was performed by one of the most skilled eye surgeons I know, Ike Ahmed (in Canada):

In addition, it’s simply not true that you cannot achieve an IOP below 10mmHg off drops after Canaloplasty. I have a number of patients who are now years out from Canaloplasty who have IOPs in the

Warm regards,
David Richardson, MD

Date: Mon, Feb 9, 2015 at 6:00 AM

 

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Can Canaloplasty NOT Be Done after a Trab W/ EX-Press or Trab Alone?

ANSWER:

Dear ******,

This is not a question that can be answered with a simple “yes” or “no”. It depends upon whether the canal was cut through during creation of the trabeculectomy site. In general it is much easier to perform Canaloplasty after an Ex-PRESS mini shunt is used as the shunt is inserted anterior (in front of) the canal. So long as the canal is intact it should be possible to fully catheterize and stent it open during Canaloplasty. That being said, it is still possible (though exceedingly challenging) to perform Canaloplasty after a trabeculectomy that has cut out a portion of the canal. More information can be found here:

Warm regards,
David Richardson, MD

Date: Fri, May 15, 2015 at 12:39 PM

 

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