Nature compares canaloplasty vs trabecular stent
- Nature journal Eye published a multicentre glaucoma study on April 28 comparing iTrack ab-interno canaloplasty with iStent micro-bypass surgery in 339 eyes. - Both procedures cut eye pressure and medication use similarly, but 42% of canaloplasty eyes were medication-free at follow-up versus 29% with iStent. - The paper adds head-to-head data for minimally invasive glaucoma surgery as surgeons move earlier than trabeculectomy in open-angle disease. (nature.com)
Glaucoma damages the optic nerve when fluid pressure inside the eye stays too high. Surgeons lower that pressure by helping fluid drain through the eye’s natural outflow channels. (nature.com 1) (nature.com 2) A stent approach places a tiny scaffold through the eye’s drain to bypass resistance. Canaloplasty instead threads a microcatheter through Schlemm’s canal and widens the channel with viscoelastic fluid. (nature.com 1) (nature.com 2) On April 28, Eye published a multicentre comparison of those two options in primary open-angle glaucoma, the most common form of the disease. (nature.com) The study used International Glaucoma Surgery Registry data and included 339 eyes: 224 treated with iTrack canaloplasty and 115 with iStent implantation. At least 94% of eyes in both groups also had cataract surgery. (nature.com) Patients in both groups started at about the same place, with baseline eye pressure near 17 millimeters of mercury and an average of 2.0 glaucoma medications. That made the head-to-head comparison cleaner. (nature.com) At last follow-up, iStent eyes went from 17.3 to 14.2 millimeters of mercury and from 2.0 to 1.3 medications. iTrack eyes went from 16.9 to 14.3 millimeters of mercury and from 2.0 to 1.1 medications. (nature.com) The paper said those reductions were not statistically different between groups. Surgical success, using an American Academy of Ophthalmology 2024 definition, was 61% in both groups. (nature.com) One number did separate the procedures: 42% of canaloplasty eyes were medication-free at follow-up, compared with 29% of stent eyes. That difference reached statistical significance with a p-value of 0.029. (nature.com) Safety looked similar too. The authors reported infrequent, self-limited complications, no sight-threatening events, and low reoperation rates after both procedures. (nature.com) The study was ambispective, meaning it mixed a prospective canaloplasty cohort with a retrospective stent cohort, rather than randomizing patients in one trial. The mean follow-up also differed: 20.3 months for iTrack and 27.2 months for iStent. (nature.com) That leaves surgeons with a practical readout rather than a knockout result. In this registry-based comparison, both minimally invasive approaches lowered pressure similarly, while canaloplasty left more patients off drops. (nature.com)
