It has been established that IOP reduction in NPDS is achieved with a number of components: subconjunctival filtering bleb, intrascleral filtering bleb, suprachoroidal filtration, and enhanced episcleral vein outflow of aqueous from Schlemm's canal
This could be due to the fact that it takes longer in canaloplasty to adjust to newly created anatomical outflow pathways, especially when Schlemm's canal
or collector channels are collapsed [18, 19].
Metformin in the aqueous humor may cleanse and open the pores in the Schlemm's canal
and uvea-scleral pathways by activation of AMPK, resulting in autophagy within the disease-afflicted lining cells of trabecular meshwork.
(Samuelson et al., 2011) The iStent is inserted through a small temporal clear corneal incision, bypassing the trabecular meshwork, and placed in Schlemm's canal
at the lower nasal quadrant.
Canaloplasty is a relatively new nonperforating blebless technique, quite similar to Stegmann's viscocanalostomy , in which a 10-0 prolene suture is positioned and tensioned within Schlemm's canal
after the injection of a small amount of high viscosity sodium hyaluronate, thus facilitating aqueous outflow through natural pathways (collectors channels and aqueous veins) [2-12].
Radial incision was performed until scleral spur fibers were observed and Schlemm's canal
was exposed (Figure 1-B).
The 14 articles discuss conventional glaucoma procedures like trabeculectomy, deep sclerectomy, and glaucoma drainage device surgery; postoperative management of filtering procedures; the role of the ocular surface and the issue of modulation of the scarring processes; new devices and techniques, such as the Ex-PRESS mini-glaucoma device, laser-assisted techniques, and Schlemm's canal
surgery; and surgical approaches to specific and challenging forms of glaucoma, including angle-closure glaucoma, concomitant cataract and glaucoma, pediatric glaucoma, and refractory glaucomas.
The iStent inject is designed to optimize the natural physiological outflow of aqueous humor by creating two patent bypasses through the trabecular meshwork, the main source of resistance in glaucomatous eyes, resulting in multi-directional flow through Schlemm's canal
. It includes two heparin-coated titanium stents preloaded into an auto-injection system that allows the surgeon to precisely implant stents into two trabecular meshwork locations through a single corneal entry point in a straightforward click-and-release motion.
Aqueous passes through the trabecular meshwork and into Schlemm's canal
. This, in turn is drained by the collector channels and aqueous veins, which empty into the conjunctival veins.
In 1973, the relationship between Schlemm's canal
(SC) and intraocular pressure (IOP) was reported by Johnstone and Grant .
The TRAB360 Trabeculotomy System is a fully integrated, single-handed, single-use device that offers 360-degree access to Schlemm's canal
via a single, sub-2mm, clear corneal incision.
Packaged in a pre-loaded configuration, the iStent is inserted through a small corneal incision made during cataract surgery and placed into Schlemm's canal
, a circular channel in the eye that collects aqueous humor and eventually delivers it into the bloodstream.