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• W2377076319 abstract "We enjoyed reading the article ‘trabeculectomy versus canaloplasty (TVC) in the treatment of patients with open-angle glaucoma: a prospective randomized clinical trial’ by Matlach et al (2015). The study is well designed and addresses important questions. In particular, the prospective and randomized character makes this an excellent and important article for the ophthalmological community showing that canaloplasty has a comparable intraocular pressure (IOP)-lowering effect to trabeculectomy after 2 years (Matlach et al. 2015). Trabeculectomy, although being a rather invasive and unphysiological procedure is still perceived as the first-line surgical therapy for glaucoma. Disadvantages include the postoperative need of antiproliferative substances and vision-threatening complications like long-term hypotony, choroidal detachment or bleb related infections (Rulli et al. 2013; Kim et al. 2015); therefore, less invasive surgical options have been evaluated in the past. The most promising is the canaloplasty that yields the advantages of a sufficient IOP reduction without the risks of severe complications. The excellent study by Matlach et al. supports our recent findings, where we retrospectively analysed 78 eyes operated with a modified canaloplasty technique. Mean IOP dropped from 19.10 to 13.5 mmHg with 52.6% of patients not using any topical therapy. The main variation of this novel technique is the creation of a second deep scleral flap facilitating orientation and probing of Schlemm's canal and creating an additional aqueous outflow and drainage into the suprachoroidal space (Szurman et al. 2015). We could also show that an additional IOP reduction of 41.2% can be achieved by microinvasive 360° trabeculotomy under topical anaesthesia in cases where target IOP was not achieved (Seuthe et al. 2015). Some points in the article by Matlach et al. are in our eyes misleading and should be addressed: Therefore, in our eyes, the main findings of this study are that canaloplasty is not inferior to trabeculectomy considering absolute IOP reduction with/without topical medication and that trabeculectomy yields higher chances of reaching drop-free IOP reduction <18 mmHg. This changes the dynamics of the surgical approach for treating glaucoma patients: It makes canaloplasty the first-line surgical strategy yielding the same IOP-lowering potential with less severe side-effects than trabeculectomy and more attractive postoperative strategies if target IOP is not reached. Trabeculectomy will in our eyes remain an attractive second line therapy besides deep sclerectomy. We should be asking ourselves the question: which of the two equal IOP-lowering procedures is preferable - the one with 50% chance of having to use additional topical therapy or the one with a 25% possibility for additional topical therapy but with high chances of severe intra- and postoperative complications and failure. The answer is given by Mattlach et al. in this excellent article but could be emphasized with less subtlety." @default.
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• W2377076319 date "2016-04-04" @default.
• W2377076319 modified "2023-10-14" @default.
• W2377076319 title "Is trabeculectomy really superior to canaloplasty?" @default.
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• W2377076319 doi "https://doi.org/10.1111/aos.13026" @default.
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