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    ABiC: A novel approach to ab-externo canaloplasty

    Procedure provides advantages of MIGS with efficacy of traditional canaloplasty

    TAKE HOME MESSAGE: Ab interno canaloplasty accesses, catheterizes, and viscodilates all sites controlling aqueous outflow. At 6 months, IOP lowering ranges from 33.3% to 38.4%, whether looking at all comers, eyes undergoing simultaneous cataract surgery, those not previously on glaucoma medications, and individuals with and without a history of glaucoma laser trabeculoplasty.

    By Cheryl Guttman Krader; Reviewed by Mahmoud A. Khaimi, MD

    Oklahoma City, OK—Ab interno canaloplasty (ABiC) is a unique microinvasive glaucoma surgery (MIGS) procedure that is delivering very positive early results, according to Mahmoud A. Khaimi, MD.

    Performed in a temporal approach through a 1.8-mm temporal clear corneal incision and using an illuminated microcatheter (iTrack 250A, Ellex) that provides continual trans-scleral visualization, ABiC accesses, catheterizes, and viscodilates all sites controlling aqueous outflow. And, it does so while sparing conjunctiva and without requiring placement of a tensioning suture or leaving device behind.

    To date, Dr. Khaimi has performed ABiC in eyes representing a spectrum from early to severe glaucoma. After 6 months of follow-up in 106 eyes with a baseline median IOP of 21 mmHg on 2 medications, IOPs are consistently in the low teens (average decrease ~35%) without any medication, and there have been no significant complications, he noted.

    Related: More on MICS and MIGS surgery devices

    “ABiC is essentially a foolproof technique because of the live feedback provided using the illuminated microcatheter, and it takes any guesswork out of the efficacy equation because it targets all potential sites of outflow resistance that may be present in the trabecular meshwork, Schlemm’s canal, or collector channels,” said Dr. Khaimi, clinical associate professor of ophthalmology, Dean McGee Eye Institute, University of Oklahoma College of Medicine, Oklahoma City. “In fact, it is the only MIGS procedure to address the collector channels.

    “Results from follow-up to 6 months are very encouraging, and we are looking forward to analyzing our 1 year results soon,” he added.

    Dr. Khaimi said the idea for ABiC emerged based on his follow-up of patients who underwent ab externo canaloplasty in whom viscodilation was performed only without placing the tensioning suture.. Looking at their outcomes after 3 years, Dr. Khaimi noticed that IOP control remained good, and his observation that 360º viscodilation alone was effective was corroborated by data from Richard Lewis, MD, and other surgeons performing traditional canaloplasty.

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