Clinical Applications

In an ab-interno approach, Schlemm’s canal is accessed from within the anterior chamber under gonioscopic visualization. The procedure is performed through a small corneal incision, enabling canal catheterization and viscodilation while avoiding external conjunctival dissection.

With iTrack™ Advance, ab-interno canaloplasty is performed by accessing Schlemm’s canal from within the eye, advancing a microcatheter through the canal and delivering viscoelastic to viscodilate the pathway as the catheter is withdrawn. The steps below summarize the procedural concept at a high level. For full details, refer to the IFU.

Step 1

Corneal incision

Under gonioscopic visualization, Schlemm’s canal is accessed through a small corneal incision and the microcatheter is introduced into the canal.

Step 2

Cannula insertion

Using the cannula tip, pierce the upper most anterior portion of pigemented trabecular meshwork at a 15° angle. Release the forward pressure with the cannula tip. Rest the cannula tip against the scleral wall. Take care to remain as static as possible. Ensure the cannula is orientated parallel with Schlemm’s canal.

Step 3

Canal intubation

Use the actuator to slowly advance microcatheter into Schlemm’s canal. If resistance is felt, re-adjust the position of the cannula tip and gently try again. Verify microcatheter is in Schlemm’s canal via the illuminated tip.

Step 4

Cannula insertion

Using the cannula tip, pierce the upper most anterior portion of pigemented trabecular meshwork at a 15° angle. Release the forward pressure with the cannula tip. Rest the cannula tip against the scleral wall. Take care to remain as static as possible. Ensure the cannula is orientated parallel with Schlemm’s canal.

Step 5

Viscodilation

Use actuator to slowly withdraw microcatheter from Schlemm’s canal while instructing scrub nurse to simultaneously deliver viscoelastic via the ViscoInjector.
Healon Pro: 9 clicks per quadrant (36 clicks over 360°)ProVisc: 9 clicks per quadrant (36 clicks over 360°)

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In an ab-externo canaloplasty technique, Schlemm’s canal is accessed through a scleral approach. The canal can then be intubated with a microcatheter to support catheterization and viscodilation of Schlemm’s canal as part of a canaloplasty procedure.

Most glaucoma treatments fail to completely address the natural outflow system and may even disturb the natural outflow function. Unlike traditional glaucoma surgeries (trabeculectomy and tube shunts), which bypass the natural outflow system, canaloplasty works by restoring the natural ocular outflow function in four keysteps:

Step 1

Creation of the outer flap to enable access for the ab-externo approach.

Step 2

Creation of the inner flap to expose Schlemm’s canal and prepare for intubation.

Step 3

Intubation of Schlemm’s canal with the microcatheter, with catheterization and viscodilation performed per the IFU.

Step 4

Suture placement, followed by outer flap closure using standard technique.

Step 5

The outer flap is closed to ensure precise alignment and healing.

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