Ab-Interno Canaloplasty and Ab-Interno Canaloplasty/Trabeculotomy in Glaucoma Patients Using the OMNI Surgical System

Abstract

Eyes with Primary Open Angle Glaucoma (POAG) show anatomical changes within the trabecular outflow tract that increase aqueous humor outflow resistance and thus Intraocular Pressure (IOP). In these glaucomatous eyes, approximately 50–70% of the total outflow resistance is attributed by changes in the tissue of the Trabecular Meshwork (TM) and 30–50% by changes in Schlemm’s canal and/or the collector canals. In the last decade, a number of Minimally Invasive Glaucoma Surgeries (MIGS) have been developed to target the different tissue changes particularly. For example, goniotomy, trabeculotomy, and trans-TM implants target TM resistance, whereas canaloplasty, viscodilation, and stenting procedures target Schlemm’s canal and collector channels. Therefore, a procedure targeting multiple pathways of aqueous humor outflow might be more effective in lowering IOP. In a limited number of studies to date using the OMNI Surgical System either combined with phacoemulsification or as standalone system, IOP reductions of 20–35% and medication reductions of 25–75% have been reported. In this chapter, the experience in performing canaloplasty/trabeculotomy of Schlemm’s canal and distal collector channels using the OMNI Surgical System is described.