2020 Huntington Dr, San Marino, CA 91108

QUESTION:

Hope I am not inconveniencing you in anyway by sending this email directly to you. I would like to know if you can help me with my glaucoma if I come to your clinic in California. I live in Missouri. It may take a while as I am retired and need to get the finance together before coming to see you.

Here is the problem I am facing. I have had canaloplasty surgery on ***. The surgeon did not place stents in the drainage canal as you and others do. He place the sutures.

On July 12th during the follow-up with the doctor, my IOP was at 3 and the surgeon said everything seems to be good and he can see the fluid draining through the drainage system of the eye. On *** during the 7th day check up my IOP was at 6.

I came home after this and went back to the surgeon on *** for the one month check up. At this time my IOP spiked and was at 22. Now, the surgeon said I may have blockage on the internal draining system and wants to Trab surgery. I am really worried and very hesitant to do trab surgery just one moth after Canaloplasty.

It is hard for me to believe the drainage system in my eye is clogged if my IOP is 3 and 6, one week after surgery. This shows the drainage system is working and now is at 22, one month after surgery. This tells me may be there is a blockage in the Schlemm’s Canal.

I would like to get your opinion on this and would like to know if you can help? Or one month is too early to predict the IOP pressure fluctuation after the canaloplasty surgery? Can one redo the canaloplasty surgery again on the same eye?

Thank you in advance for your advise and hope you can help me as I do not want to do the trab surgery.

R**** via Email


ANSWER:

Hello R****,

When a suture is placed at the time of canaloplasty there is much that can still be done to achieve additional IOP reduction if needed: YAG goniopuncture or Micro Invasive Suture Trabeculotomy (MIST), for example. Goniopuncture may still be possible even without suture placement, but MIST requires a suture in the canal in order to be done.
In addition, there can be a transient elevation in IOP anywhere between weeks one and four. This is thought to be due to blood clotting in the canal or collector channels. These clots generally clear after a week or so. As such, and unless the IOP is high enough to cause imminent harm to the optic nerve, I personally do not move quickly to additional surgery (other than YAG goniopuncture) within the first two to three months after canaloplasty.
With regard to “redoing” canaloplasty, it’s rarely attempted. The surgery is difficult enough without the additional challenge of working through scar tissue.
I’ve copied my nurse, Ana, on this email. She would be the one you should contact if you wish to schedule a consultation with me in the future.

 

Warm regards,
David Richardson, MD
Patient-Focused Ophthalmologist

San Marino Eye
2020 Huntington Drive
San Marino, CA 91108
626.289.7856

Patient-Focused Websites:
New-Glaucoma-Treatments.com
About-Eyes.com

Posted in: Canaloplasty, Canaloplasty and Other Surgeries, Canaloplasty and Recovery, Canaloplasty Safety and Efficacy