Efficacy of bleb-independent penetrating canaloplasty in primary angle-closure glaucoma: one-year results

Purpose To report the efficacy and safety of bleb-independent penetrating canaloplasty in the management of primary angle-closure glaucoma (PACG). Methods This single-centre prospective interventional case series enrolled 57 eyes from 53 PACG patients with medically uncontrolled intraocular pressure (IOP) and peripheral anterior synechiae of over 270 degrees. Penetrating canaloplasty, mainly consisted of tensioning suture-aided Schlemm's canal dilation and a trabeculectomy, was performed to create a direct communication between the anterior chamber and the Schlemm's canal. Postoperative IOP, number of glaucoma medications and procedure-related complications were evaluated. Rate of success was defined as IOP <= 21, <= 18 and <= 15 mmHg, and a >= 30% IOP reduction without (complete) or with/without (qualified) IOP-lowering medications. Results A total of 45 eyes had 360 degrees catheterization successfully completed. The mean preoperative IOP was 33.9 +/- 11.7 mmHg (range, 13-59.6 mmHg), on 3.2 +/- 0.8 glaucoma medications (range 2-5), which was decreased to 15.4 +/- 3.7 mmHg (range, 8.6-22.5) and 0.2 +/- 0.6 (range, 0-3) medications at 6 months and 14.8 +/- 3.5 mmHg (range, 9-24) and 0.1 +/- 0.3 (range, 0-1) medications at 12 months postoperatively. Complete success at 12 months were achieved in 78.9% (95% CI: 0.65-0.93), 71.1% (0.56-0.86) and 50.0% (0.33-0.67) eyes at IOP <= 21, <= 18 and <= 15 mmHg, respectively. Transient IOP elevation (>30 mmHg, 26.7%) and hyphema (11.1%) were the most common early surgical complications. Conclusion Penetrating canaloplasty in PACG appeared to have good efficacy and safety profiles in this pilot study. Further studies are justified.