Abstract

FR.10.06

Canaloplasty and transient anterior chamber hemorrhage: a prognostic factor?

Jörg Koch, Arnd Heiligenhaus, Carsten Heinz

Augenabteilung am St. Franziskus Hospital, Münster

Objective
An attempt to evaluate transient anterior chamber (AC) hemorrhage after Canaloplasty.
Methods
In a period from November 2008 to April 2009 a total of 15 eyes in 11 patients underwent Canaloplasty for primary open angle glaucoma at the Department of Ophthalmology at St Francis Hospital in Munster. At the end of surgery and after a successful 360 degree catheterization of Schlemm´s canal, applying a 200µm microcatheter (iTrack, iScience Surgical Corp, Menlo Park, California), complete Viscocanalostomy, placememt of a 10-0 Prolene suture, tied to apply permanent tension to the trabecular meshwork and a waterproof wound closure, all eyes left the surgical table with an intraocular pressure (IOP) of 5-10 mmHg and a deep AC without any bleeding.
Results
The IOP on day 1 after surgery was 9.07 mmHg (min. 1 mmHg, max. 20 mmHg -Schioetz). By that time 14 of 15 eyes showed AC hemorrhage with a hyphaema between 0.5-2 mm in height. The one eye without bleeding showed an IOP of 20 mmHg at the same time and maintained IOP above 13 mmHg in the subsequent period. In no case there was further bleeding, the blood got absorbed in all cases within a maximum of 1 week without further complications.
Conclusions
In contrast to Trabeculectomy, where the natural AC water outflow gets bypassed via an artificial fistula, Canaloplasty tempts to re-establish the physiological AC water draining system by a 360 degree Viscocanalostomy and a thread mediated dilation of Schlemm´s canal and its collector channels. If the AC pressure temporarily lowers the level of the venous capillary pressure, it is consistent with a patent piping system that a reverse flow with blood reflux into the AC can be observed as long as a minimal physiological pressure gradient from the anterior chamber in the direction of channel Schlemm's canal is restored. Thus, to the authors opinion, AC haemorrhage shows the desired consistency of the water draining system and should therefore logically to be expected after each successful operation in all cases, where ocular hypotony in the post operative period occurs.

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