The external canaloplasty approach was FDA approved in 2007 and over the years has shown to be a very viable procedure to effectively lower the IOP in glaucoma patients. Though efficacious, the technique has been received as a very technically challenging surgical option. The mechanism of increasing aqueous flow with canaloplasty is accomplished using a micro-catheter that enters through the TM and into SC for 360 degrees. Release of viscoelastic behind the TM that separates compressed tissue planes, dilates SC and the more distal collector channels. The external approach involves cutting into conjunctiva in an extremely detailed fashion. There are two newly-available (2015) MIGS procedures that allow canaloplasty through an ab-interno approach providing a much simpler technique, and with similar positive outcomes: Visco360 (Sight Sciences) and ab interno canaloplasty, or ABiC (Ellex).
Visco360 (Sight Sciences) is a single unit disposable device that at first glance looks almost identical to the aforementioned Trab360 instrument. Where they differ is that the Visco360 device also features an internally integrated infusion pump and reservoir for viscoelastic that allows for controlled delivery of viscoelastic fluid anywhere in the AC.
Watch a video of Visco360 surgery
Read more about the Visco360 procedure in an article in Review of Optometry, by Dr. Okeke, entitled, “Expanding Outflow with MIGS”.
Ab-Interno Canaloplasty (ABiC)
Ab-Interno Canaloplasty (ABiC) was recently launched by Ellex, who acquired iScience, Inc and the canaloplasty portfolio in 2013. With the creation of the ABiC procedure, a simpler internal approach to canaloplasty is provided, while still utilizing a light source, the patented micro-catheter with an illuminated tip and open inner lumen to inject high viscosity viscoelastic for a safe and effective 360 degree dilation of SC, the trabecular meshwork, and the outflow collector channels.
Read more about the ABiC procedure in an article in Glaucoma Today, entitled, “Ab Interno Canaloplasty“.