FAQs / Does Canaloplasty Work For Only About Six Months?

QUESTION:

I was told by my surgeon that Canaloplasty only works for about six months after which the drainage system blocks up again. Is this true?

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ANSWER:

This statement is simply not supported by either the literature or the experience of skilled Canaloplasty surgeons.

I recommend that anytime a surgeon makes a disparaging comment about any surgery that the individual with glaucoma ask, “Given that is your experience, how many of that surgery have you personally performed?” The answer will often be revealing. In the case of Canaloplasty (a very technically challenging surgery) most surgeons with only 25 or so cases will not observe the full IOP-lowering potential of Canaloplasty as they are still very much on the steep learning curve. The fact of the matter is that most surgeons (nay, most people) simply don’t have the patience to pursue any activity dozens of times in order to achieve a level of proficiency. As such, it’s completely understandable that busy surgeons who already have glaucoma surgeries that “work” in their hand feel little incentive to add Canaloplasty to their skill set.

I have been performing Canaloplasty as my primary non-laser glaucoma surgery since 2011. I am still following many of my patients who had Canaloplasty 5-6 years ago. Most of them still have well-controlled IOPs. If Canaloplasty didn’t work (or only worked for six months), I would have stopped recommending it years ago.

That being said, there are certain types of glaucoma that are more likely to “re-clog” the drainage system after a period of time. For example, Canaloplasty may not be the best surgical option in those with pigmentary or inflammatory glaucomas. Any glaucoma surgery that depends upon the natural drainage system (trabecular meshwork + Schlemm’s canal + collector channels) is going to be at risk of failing to control the IOP in pigmentary or inflammatory glaucomas. Whatever clogs the trabecular meshwork is likely also clogging the “downstream” drainage so expansion of Schlemm’s canal (which addresses only one area of obstruction) may not be sufficient to achieve adequate and long-term IOP lowering. In these glaucomas a true bypass surgery (i.e., trab or tube) may be the better surgical option.

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 Safety and Efficacy