It's a pathway that's delivering real breakthroughs — particularly when it comes to reducing the use of medications as the main option in glaucoma treatment. Frequently, glaucoma patients struggle to comply with medication regimens, and many also suffer from side effects, including burning, dry eye, conjunctival hyperemia, foreign body sensation and tearing.
With a mild touch and manifest efficacy, ABiC™ performed with the iTrack™ surgical system is a comprehensive minimally invasive canal-based glaucoma surgery that can effectively reduce IOP and eliminate or reduce the medication burden. Restorative and atraumatic, ABiC™ can be performed across the entire glaucoma disease process – and in conjunction with other treatments and MIGS options.
Canaloplasty performed with the iTrack™ surgical system is ideally suited to patients with later stage glaucoma and is a proven and effective solution that targets the natural outflow pathway to restore outflow.
Performed with the iTrack™ surgical system from Ellex, ABiC™ comprehensively addresses blockages in the collector channels and flushes the outflow channels without damaging tissue and without leaving behind a stent or shunt.
ABiC™ re-establishes the eye’s natural outflow system by accessing, catheterizing and viscodilating the trabecular meshwork, Schlemm’s canal, and the distal outflow system. 360º viscodilation of Schlemm’s canal can separate the compressed tissue planes of the trabecular meshwork, causing any herniated inner wall tissue to withdraw from the collector channels. This complements the mechanic opening achieved via the circumnavigation of the iTrack™ microcatheter through Schlemm’s canal.
For patients with later stage glaucoma disease, Canaloplasty, performed with the iTrack™ surgical system is a proven and effective solution that means patients avoid the risks and discomfort associated with trabeculectomy. By addressing all possible resistance sites, including potentially occluded collector channels, Canaloplasty delivers post-operative pressures in the range of 12-14 mmHg, similar to that achieved with trabeculectomy — but with fewer complications and an improved safety profile 2,3 . Because there’s no filtering bleb, Canaloplasty also offers a simplified postoperative course, with patients able to resume their day-to-day activities directly following treatment.
2. Lewis RA, von Wolff K, Tetz M, et al. Canaloplasty: three-year results of circumferential viscodilation and tensioning of Schlemm’s canal using a microcatheter to treat open-angle glaucoma. J Cataract Refract. Surg. 2011(37):682-690.
3. Clin Exp Ophthalmol. 2011;249:1537-1545.Brüggemann A, Despouy JT, Wegent A, Müller M. Intraindividual comparison of Canaloplasty versus trabeculectomy with mitomycin C in a single-surgeon series. J Glaucoma. 2013;22(7):577-583.
In a healthy eye, aqueous humor drains from the anterior chamber through progressively smaller channels of the trabecular meshwork into the circumferentially-oriented Schlemm’s canal. From Schlemm's canal, circuitous channels, known as the collector channels, wind their way toward the surface of the sclera through the intrascleral venous plexus system, joining the episcleral vasculature, which drains into the venous system. It is important to note that the collector channels are not evenly distributed around Schlemm’s canal circumferentially and that outflow is segmental, higher in areas close to the large collector channels.
Studies undertaken in human POAG eyes by Haiyan Gong, MD, PhD (University of Boston) have shown that many of the collector channels may be blocked with herniated trabecular meshwork tissue at 0mmHg and become progressively worse as IOP rises1. This herniated tissue does not recede in POAG eyes although it does in normal eyes. Cannulating the whole of Schlemm’s canal with ABiC™ or Canaloplasty, via a process of 360-degree viscodilation, may “pop” open these herniations and enable full access to collector channel ostia for the egressing aqueous. In the case of other glaucoma treatments, where only a segment of Schlemm’s canal is addressed, or where the trabecular meshwork is targeted in isolation, any herniated tissue would most likely prevent improved outflow.
In POAG eyes fixed at 0 mmHg (N=5), 73 collector channel ostia regions were examined, with 51 showing herniations (70%). In POAG eyes fixed at 10 mmHg (N=2), 22 collector channel ostia regions were examined, with 21 showing herniations (95%). In contrast, in normal eyes fixed at 0 mmHg, 53 collector channel ostia regions were examined, with 8 herniations found (15%). Whilst these herniations were found to be reversible in normal eyes, they were irreversible in the POAG eyes.
1. Source: Cha ED, Xu J, Gong H. Variations in active areas of aqueous humor outflow through the trabecular outflow pathway. Presented at ARVO 2015.)
"I think that ABiC comprehensively treats outflow locations, which is why it is my first go-to MIGS procedure. I don't have the diagnostic capability to know where the obstruction is located or what level of resistance exists, so I like to start off with a MIGS that addresses everything."
"While various MIGS devices may work on specific sections of the outflow system, ABiC’s multiple mechanisms let us hedge our bets and, in my opinion, have a better chance of getting that reduction of pressure in the right type of patient population."