Multicentre registry reports outcomes comparing ab‑interno canaloplasty vs trabecular micro‑bypass
- Eye published a multicentre registry analysis on April 28 comparing iTrack ab-interno canaloplasty with iStent in 339 eyes with primary open-angle glaucoma. - Both procedures lowered pressure and medications similarly, but canaloplasty left more eyes medication-free at follow-up: 42% versus 29%, with equal 61% success. - Most eyes also had cataract surgery, reflecting how minimally invasive glaucoma procedures are commonly used in practice today. (aaojournal.org)
Glaucoma surgery aims to lower pressure inside the eye so the optic nerve takes less damage over time. A new Eye paper compares two “minimally invasive” ways to do that in routine practice. (nature.com) The study, published April 28, used the International Glaucoma Surgery Registry to compare iTrack ab-interno canaloplasty with iStent trabecular micro-bypass surgery in mild-to-moderate primary open-angle glaucoma. It included 339 eyes: 224 treated with iTrack and 115 with iStent. (nature.com) Canaloplasty works by threading a tiny catheter through the eye’s drainage canal and widening it from within, like clearing and stretching a clogged pipe. A trabecular micro-bypass stent works differently: it leaves behind a tiny implant that creates a direct path through the eye’s main drainage tissue. (nature.com) (eyewiki.org) At baseline, the two groups looked similar on the main measures the study tracked. Mean intraocular pressure was 17.3 mmHg in the iStent group and 16.9 mmHg in the iTrack group, and both groups averaged 2.0 glaucoma medications. (nature.com) By last follow-up, pressure fell to 14.2 mmHg after iStent and 14.3 mmHg after iTrack, and medication use fell to 1.3 and 1.1 drugs respectively. The differences in pressure reduction and medication reduction between groups were not statistically significant. (nature.com) One result did separate the groups: 42% of canaloplasty eyes were medication-free at follow-up, compared with 29% of stent eyes. The paper also reported identical overall success rates of 61% under American Academy of Ophthalmology 2024 reporting criteria. (nature.com) (aao.org) Safety was similar on the broad outcomes the registry captured. The authors reported infrequent, self-limited complications, no sight-threatening events, and low reoperation rates in both groups. (nature.com) This was not a head-to-head randomized trial. The canaloplasty cases were collected prospectively, the iStent cases retrospectively, and follow-up length differed too: 20.3 months on average for iTrack versus 27.2 months for iStent. (nature.com) The study also reflects how these procedures are often used in the real world: at least 94% of eyes in both groups had cataract surgery at the same time. The American Academy of Ophthalmology said in 2024 that combined cataract-plus-MIGS cases often get much of their pressure-lowering effect from the cataract operation itself. (nature.com) (aaojournal.org) The registry itself was built to collect multicenter canaloplasty data across North America, Europe, and Asia-Pacific, with support from Nova Eye Medical, the maker of iTrack. That gives surgeons more real-world comparative data, but it also means readers will look closely at study design and sponsorship as more results arrive. (nova-eye.com) (nature.com) For now, the paper’s bottom line is narrower than a product win. In this registry, iTrack canaloplasty and iStent produced similar pressure and safety outcomes, while canaloplasty left a larger share of patients off drops altogether. (nature.com)
