Microinvasive Glaucoma Surgery: A Review of Schlemm’s Canal-Based Procedures

Joanna Konopińska,1 Katarzyna Lewczuk,2 Joanna Jabłońska,2 Zofia Mariak,1 Marek Rękas2 1Department of Ophthalmology, Medical University of Bialystok, Białystok, Poland; 2Department of Ophthalmology, Military Institute of Medicine, Warsaw, PolandCorrespondence: Joanna KonopińskaDepartment of Ophthalm...

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Autores principales: Konopińska J, Lewczuk K, Jabłońska J, Mariak Z, Rękas M
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Publicado: Dove Medical Press 2021
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spelling oai:doaj.org-article:8365e5c81b2f4acca5c80db2940cd9d32021-12-02T13:30:27ZMicroinvasive Glaucoma Surgery: A Review of Schlemm’s Canal-Based Procedures1177-5483https://doaj.org/article/8365e5c81b2f4acca5c80db2940cd9d32021-03-01T00:00:00Zhttps://www.dovepress.com/microinvasive-glaucoma-surgery-a-review-of-schlemmrsquos-canal-based-p-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Joanna Konopińska,1 Katarzyna Lewczuk,2 Joanna Jabłońska,2 Zofia Mariak,1 Marek Rękas2 1Department of Ophthalmology, Medical University of Bialystok, Białystok, Poland; 2Department of Ophthalmology, Military Institute of Medicine, Warsaw, PolandCorrespondence: Joanna KonopińskaDepartment of Ophthalmology, Medical University of Białystok, Jana Kilińskiego 1 STR, Białystok, 15-089, PolandTel +48 857468372Fax +48 857468604Email joannakonopinska@o2.plAbstract: Microinvasive glaucoma surgery has gained popularity over the past decade. It can be performed using three different mechanisms. In the present review, we focused on Schlemm’s canal (SC)-based surgery, which increases aqueous humor (AH) outflow into the aqueous veins by either removal of the trabecular meshwork (TM) or an increase in the tension in the TM. In primary open-angle glaucoma (POAG), the TM is the most likely region for increased AH outflow resistance. Theoretically, removal of the TM can improve the AH outflow; hence, glaucoma specialists focus on microsurgical dissection of the TM. In this review, we analyzed the available literature to examine SC-related microsurgical modalities based on the histopathological proofs of the localization of resistance of the AH outflow. First, we considered the role, anatomy, and physiology of the TM and SC. We referred to studies that describe the mechanisms and potential pathways, related to increased intraocular pressure in the POAG, that are targeted using the SC-related microsurgical interventions. Next, we took a closer look at the gonioscopic tools necessary for an ab-interno approach and explored incision canal surgery: ab-interno trabeculectomy using different instrumentation (Trabectome®, Kahook Dual Blade) and variations of the technique. Thereafter, we discussed ab-interno canaloplasty, explaining the technique and reviewing its effectiveness. Finally, we presented the scope for future research in the field. Although the iStent also targets SC by bypassing it, this device has been reviewed extensively elsewhere.Keywords: microsurgery, trabecular meshwork, canaloplasty, trabeculotomy, Kahook Dual Blade, Schlemm’s canalKonopińska JLewczuk KJabłońska JMariak ZRękas MDove Medical Pressarticlemicrosurgerytrabecular meshworkcanaloplastytrabeculotomykahook dual bladeschlemm’s canalOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 15, Pp 1109-1118 (2021)
institution DOAJ
collection DOAJ
language EN
topic microsurgery
trabecular meshwork
canaloplasty
trabeculotomy
kahook dual blade
schlemm’s canal
Ophthalmology
RE1-994
spellingShingle microsurgery
trabecular meshwork
canaloplasty
trabeculotomy
kahook dual blade
schlemm’s canal
Ophthalmology
RE1-994
Konopińska J
Lewczuk K
Jabłońska J
Mariak Z
Rękas M
Microinvasive Glaucoma Surgery: A Review of Schlemm’s Canal-Based Procedures
description Joanna Konopińska,1 Katarzyna Lewczuk,2 Joanna Jabłońska,2 Zofia Mariak,1 Marek Rękas2 1Department of Ophthalmology, Medical University of Bialystok, Białystok, Poland; 2Department of Ophthalmology, Military Institute of Medicine, Warsaw, PolandCorrespondence: Joanna KonopińskaDepartment of Ophthalmology, Medical University of Białystok, Jana Kilińskiego 1 STR, Białystok, 15-089, PolandTel +48 857468372Fax +48 857468604Email joannakonopinska@o2.plAbstract: Microinvasive glaucoma surgery has gained popularity over the past decade. It can be performed using three different mechanisms. In the present review, we focused on Schlemm’s canal (SC)-based surgery, which increases aqueous humor (AH) outflow into the aqueous veins by either removal of the trabecular meshwork (TM) or an increase in the tension in the TM. In primary open-angle glaucoma (POAG), the TM is the most likely region for increased AH outflow resistance. Theoretically, removal of the TM can improve the AH outflow; hence, glaucoma specialists focus on microsurgical dissection of the TM. In this review, we analyzed the available literature to examine SC-related microsurgical modalities based on the histopathological proofs of the localization of resistance of the AH outflow. First, we considered the role, anatomy, and physiology of the TM and SC. We referred to studies that describe the mechanisms and potential pathways, related to increased intraocular pressure in the POAG, that are targeted using the SC-related microsurgical interventions. Next, we took a closer look at the gonioscopic tools necessary for an ab-interno approach and explored incision canal surgery: ab-interno trabeculectomy using different instrumentation (Trabectome®, Kahook Dual Blade) and variations of the technique. Thereafter, we discussed ab-interno canaloplasty, explaining the technique and reviewing its effectiveness. Finally, we presented the scope for future research in the field. Although the iStent also targets SC by bypassing it, this device has been reviewed extensively elsewhere.Keywords: microsurgery, trabecular meshwork, canaloplasty, trabeculotomy, Kahook Dual Blade, Schlemm’s canal
format article
author Konopińska J
Lewczuk K
Jabłońska J
Mariak Z
Rękas M
author_facet Konopińska J
Lewczuk K
Jabłońska J
Mariak Z
Rękas M
author_sort Konopińska J
title Microinvasive Glaucoma Surgery: A Review of Schlemm’s Canal-Based Procedures
title_short Microinvasive Glaucoma Surgery: A Review of Schlemm’s Canal-Based Procedures
title_full Microinvasive Glaucoma Surgery: A Review of Schlemm’s Canal-Based Procedures
title_fullStr Microinvasive Glaucoma Surgery: A Review of Schlemm’s Canal-Based Procedures
title_full_unstemmed Microinvasive Glaucoma Surgery: A Review of Schlemm’s Canal-Based Procedures
title_sort microinvasive glaucoma surgery: a review of schlemm’s canal-based procedures
publisher Dove Medical Press
publishDate 2021
url https://doaj.org/article/8365e5c81b2f4acca5c80db2940cd9d3
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AT jabłonskaj microinvasiveglaucomasurgeryareviewofschlemmrsquoscanalbasedprocedures
AT mariakz microinvasiveglaucomasurgeryareviewofschlemmrsquoscanalbasedprocedures
AT rekasm microinvasiveglaucomasurgeryareviewofschlemmrsquoscanalbasedprocedures
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