Via360 used to reduce glaucoma drops

Why it matters

Edward Yung, MD, on May 13, 2025 published an Ophthalmology Times case discussion about a 70-year-old man with open-angle glaucoma whose care was complicated by poor adherence to eyedrops. The case described cataract extraction combined with canaloplasty and trabeculotomy using the Via360 device after the patient developed progressive visual field loss, worst in the left eye. Yung said the combined minimally invasive glaucoma surgery, or MIGS, approach was selected because the patient was not reliably following medical therapy and had unreliable follow-up. Postoperatively, Ophthalmology Times said, intraocular pressure was reduced and medication tapering was started. ### Which patient made this surgical choice notable? The patient in Yung's May 13, 2025 case was a 70-year-old man with open-angle glaucoma, cataract, poor medication adherence and progressive field loss. Ophthalmology Times said his initial medical treatment was further complicated by a follicular reaction to brimonidine, narrowing the usefulness of drop-based management. (ophthalmologytimes.com) That combination — worsening disease, adherence problems and intolerance to at least one medication — framed the decision to move from eyedrops toward a combined cataract-MIGS procedure. Yung said the operation was chosen in part to reduce the risks tied to filtering surgery in a patient whose follow-up was unreliable. ### What was done in the operating room? (ophthalmologytimes.com) The procedure combined cataract extraction with two angle-based glaucoma maneuvers: canaloplasty and trabeculotomy. Ophthalmology Times said the surgeons used the Via360 device to perform those steps in the same setting as cataract surgery. Canaloplasty targets Schlemm's canal by catheterizing and viscodilating it, while trabeculotomy cuts through trabecular meshwork tissue to improve aqueous outflow. (ophthalmologytimes.com) Sight Sciences describes the same canaloplasty-followed-by-trabeculotomy sequence for its OMNI system, another implant-free MIGS platform used in primary open-angle glaucoma, providing a procedural reference point for the approach discussed in the case. ### Why did the panel tie the operation to drop adherence? (ophthalmologytimes.com) Ophthalmology Times said poor adherence was not a side detail in the case; it was one of the reasons surgeons moved to surgery. The publication described the Via360-assisted combination as an effective MIGS option that lowered intraocular pressure while reducing medication burden and helping the patient avoid filtering surgery in that scenario. (omnisurgical.com) The case therefore linked procedure choice to a practical management problem: a patient who was not consistently using drops and was difficult to monitor after visits. Yung attributed the surgical selection to those follow-up and compliance concerns, not only to the pressure target itself. ### How much outside evidence supports this kind of combined approach? (ophthalmologytimes.com) A 2021 prospective multicenter study known as GEMINI reported outcomes for 137 patients treated with 360-degree canaloplasty and 180-degree trabeculotomy combined with phacoemulsification in open-angle glaucoma. At six months, mean diurnal intraocular pressure fell to 14.2 mmHg from a washed-out baseline of 23.8 mmHg, and 78% of patients were medication-free, according to the study published in Clinical Ophthalmology. (ophthalmologytimes.com) A 36-month extension of GEMINI reported that 74% of patients were medication-free at 36 months and mean medication use fell to 0.3 from 1.7 at baseline. The extension studied OMNI rather than Via360, but it evaluated the same basic combination of canaloplasty and trabeculotomy with cataract surgery in primary open-angle glaucoma. ### What can and cannot be concluded from this case? The Ophthalmology Times report was a single case discussion, not a head-to-head trial or a registry analysis. (pmc.ncbi.nlm.nih.gov) The publication said only that postoperative pressure reduction was achieved and medication tapering was initiated; it did not provide a full table of preoperative and postoperative pressure readings in the text that was publicly accessible. (tandfonline.com) The May 13, 2025 Ophthalmology Times roundtable placed this case alongside separate sessions on nonimplant MIGS and another canaloplasty case. Those adjacent sessions indicate the publication framed the Via360 case as part of a broader discussion of implant-free glaucoma procedures rather than as a standalone comparative study. (ophthalmologytimes.com 1) (ophthalmologytimes.com 2)

Key numbers

• Edward Yung, MD, presented a May 13, 2025 Ophthalmology Times case describing cataract surgery plus canaloplasty and trabeculotomy with Via360 in open-angle glaucoma.
• The patient was a 70-year-old man with poor adherence and progressive visual field loss; after surgery, intraocular pressure fell and medication tapering began.
• The case appears in Ophthalmology Times' May 13, 2025 roundtable series, alongside sessions on nonimplant MIGS and a second canaloplasty case.
• Edward Yung, MD, on May 13, 2025 published an Ophthalmology Times case discussion about a 70-year-old man with open-angle glaucoma whose care was complicated by poor adherence to eyedrops.

What happens next

• Edward Yung, MD, on May 13, 2025 published an Ophthalmology Times case discussion about a 70-year-old man with open-angle glaucoma whose care was complicated by poor adherence to eyedrops.
• The patient in Yung's May 13, 2025 case was a 70-year-old man with open-angle glaucoma, cataract, poor medication adherence and progressive field loss.
• Canaloplasty targets Schlemm's canal by catheterizing and viscodilating it, while trabeculotomy cuts through trabecular meshwork tissue to improve aqueous outflow.

Sources

• ophthalmologytimes.com
• omnisurgical.com
• pmc.ncbi.nlm.nih.gov
• tandfonline.com
• ophthalmologytimes.com 1

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