What is Ab interno canaloplasty with iTrack (Microcatheter)

From the Guidelines

Ab interno canaloplasty with iTrack (Microcatheter) is a minimally invasive glaucoma surgery (MIGS) option that appears to be comparable in efficacy to ab externo canaloplasty, as noted in the 2021 primary open-angle glaucoma preferred practice pattern 1. The procedure involves accessing Schlemm's canal from inside the eye and using a microcatheter to improve aqueous outflow through the eye's natural drainage system. Some key points about the procedure include:

• It can be performed as a standalone surgery or combined with cataract extraction
• Typical outcomes include intraocular pressure reduction and decreased medication burden
• Recovery is generally quick with minimal complications compared to traditional filtering surgeries
• The most common side effects include temporary hyphema and transient IOP spikes
• The use of a microcatheter, such as the iTrack system, allows for precise treatment and minimal disruption to the surrounding tissue, as seen with the OMNI Surgical System 1. The iTrack system features an illuminated tip that allows the surgeon to track the catheter's position throughout the procedure, ensuring proper placement and treatment. This procedure is particularly suitable for patients with mild to moderate glaucoma who wish to reduce medication burden or those who are not candidates for more invasive procedures.

From the Research

Ab interno Canaloplasty with iTrack (Microcatheter)

Ab interno canaloplasty with iTrack (microcatheter) is a minimally invasive glaucoma procedure that aims to reduce intraocular pressure (IOP) and the number of glaucoma medications required by patients. The procedure involves the use of a microcatheter to circumferentially viscodilate and intubate Schlemm's canal without the placement of a tensioning suture.

Key Features of the Procedure

• The iTrack microcatheter is used to perform a 360-degree circumferential intubation and viscodilation of Schlemm's canal 2, 3, 4, 5, 6.
• The procedure can be performed as a standalone procedure or in combination with cataract surgery 2, 3, 4, 5, 6.
• The primary endpoints of the procedure are the reduction of mean IOP and the number of glaucoma medications required by patients 2, 3, 4, 5, 6.

Efficacy of the Procedure

• Studies have shown that ab interno canaloplasty with iTrack (microcatheter) is effective in reducing IOP and the number of glaucoma medications required by patients with open-angle glaucoma (OAG) 2, 3, 4, 6.
• The procedure has also been shown to be effective in reducing IOP and the number of glaucoma medications required by patients with primary angle-closure glaucoma (PACG) 5.
• The reduction in IOP and glaucoma medications has been sustained for up to 4 years after the procedure 3.

Safety of the Procedure

• The procedure has been shown to be safe with minimal complications, including limited descemetolysis near the limbus 2, 6.
• No serious intraoperative or postoperative complications have been reported in studies evaluating the safety and efficacy of the procedure 3, 4, 5.

Patient Selection

• Patients with OAG or PACG who are intolerant to medications or have uncontrolled IOP may be suitable candidates for the procedure 3, 5.
• Patients with mild, moderate, or severe glaucoma may also be suitable candidates for the procedure 4, 5.