Using proprietary microcatheter technology, canaloplasty is a true 360° minimally invasive glaucoma surgery that addresses the entire conventional outflow pathway, including the trabecular meshwork, Schlemm’s canal and the collector channels. It does not remove or damage tissue and does not require a permanent stent or implant. As an added benefit, iTrack™ is cleared for use as a standalone procedure and in combination with cataract surgery.
Stent-Free MIGS Procedure
30% average IOP reduction
Standalone or Combined Procedure
What does iTrack™ do differently to other MIGS devices?
Rather than attempt to mechanically change or bypass the pathway of aqueous outflow, iTrack™ acts to re-establish the natural flow of aqueous throughout 360° of the conventional outflow pathway. Akin to angioplasty of the eye, iTrack™ combines a process of catheterization and pressurized viscodilation to address all potential points of blockage in the trabecular meshwork, Schlemm’s canal and the collector channels.
iTrack™ comprehensively treats outflow locations, which is why it is my first go-to glaucoma procedure. I don’t have the diagnostic capability to know where the obstruction is located or what level of resistance exists, and so I like to start off with a MIGS that addresses everything.
Up to 75% of the resistance to aqueous humor outflow is localized within the trabecular meshwork.1
iTrack™ separates the compressed trabecular plates of the trabecular meshwork and creates microperforations into the anterior chamber.2 – 4
1. Manik Goel, Renata G Picciani, Richard K Lee, and Sanjoy K Bhattacharya. Aqueous Humor Dynamics: A Review. Open Ophthalmol J. 2010; 4: 52 – 59. 2. Stegmann R, Pienaar A, Miller D. Viscocanalostomy for open-angle glaucoma in black African patients. J Cataract Refract Surg. 1999;25(3):316 – 322.3. Grieshaber MC, Pienaar A, Olivier J, Stegmann R. Clinical evaluation of the aqueous outflow system in primary open-angle glaucoma for canaloplasty. Invest Ophthalmol Vis Sci. 2010;51(3):1498 – 1504.4. Smit BA, Johnstone MA. Effects of viscoelastic injection into Schlemm’s canal in primate and human eyes: potential relevance to viscocanalostomy. Ophthalmology. 2002;109(4):786 – 792.
2
SCHLEMM’S CANAL
Narrow or collapsed Schlemm’s canal correlates with a decrease in outflow facility1 by as much as 50% in POAG eyes.2
iTrack™ mechanically breaks adhesions within Schlemm’s canal and dilates the canal by up to 2 – 3 times via a process of pressurized viscodilation.3 – 5
1. Johnstone MA, Grant WG. Pressure-dependent changes in structures of the aqueous outflow system of human and monkey eyes. Am J Ophthalmol. 1973;75:365 – 3832. Allingham RR, de Kater AW, Ethier CR. Schlemm’s canal and primary open angle glaucoma: correlation between Schlemm’s canal dimensions and outflow facility. Exp Eye Res. 1996;62(1):101 – 109.3. Stegmann R, Pienaar A, Miller D. Viscocanalostomy for open-angle glaucoma in black African patients. J Cataract Refract Surg. 1999;25(3):316 – 322.4. Grieshaber MC, Pienaar A, Olivier J, Stegmann R. Clinical evaluation of the aqueous outflow system in primary open-angle glaucoma for canaloplasty. Invest Ophthalmol Vis Sci. 2010;51(3):1498 – 1504.5. Smit BA, Johnstone MA. Effects of viscoelastic injection into Schlemm’s canal in primate and human eyes: potential relevance to viscocanalostomy. Ophthalmology. 2002;109(4):786 – 792.
3
COLLECTORCHANNELS
Up to 90% of collector channels may be blocked by herniated trabecular meshwork in POAG eyes.1,2
iTrack™ reduces herniations in the collector channels via a process of pressurized viscodilation.3 – 5
1. Gong H, et al. Reduction of the available area for Aqueous humor outflow and increase in meshwork herniations into collector channels following acute IOP elevation in bovine eyes. Invest. Ophthalmol Vis Sci 2008; 49:5346 – 5352.2. Gong H and Francis A: Schlemm’s Canal and Collector Channels as Therapeutic Targets. In Innovations in Glaucoma Surgery, Samples JR and Ahmed I eds. Chapter 1, page 3 – 25, Springer New York, 2014.3. Stegmann R, Pienaar A, Miller D. Viscocanalostomy for open-angle glaucoma in black African patients. J Cataract Refract Surg. 1999;25(3):316 – 322.4. Grieshaber MC, Pienaar A, Olivier J, Stegmann R. Clinical evaluation of the aqueous outflow system in primary open-angle glaucoma for canaloplasty. Invest Ophthalmol Vis Sci. 2010;51(3):1498 – 1504.5. Smit BA, Johnstone MA. Effects of viscoelastic injection into Schlemm’s canal in primate and human eyes: potential relevance to viscocanalostomy. Ophthalmology. 2002;109(4):786 – 792.
Why should MIGS devices spare, and not tear, the trabecular meshwork?
Glaucoma is a chronic, progressive disease that has no cure. To that end, the preservation of tissue to enable future treatment intervention is an important consideration. iTrack™ uses a combination of 360° catheterization and pressurized viscodilation to reduce IOP, without removing trabecular meshwork tissue. Indeed, iTrack™ preserves both the conjunctiva and angle for future procedures, if required. iTrack™ has also been shown to minimize complications associated with postoperative inflammation.
I view the angle as the new conjunctiva, because I want to manipulate it today – but I also want to preserve tissue. We all know that there’s not a single glaucoma procedure that lasts forever. I want to be able to come back and treat the patient again.
Gallardo MJ. 36-month effectiveness of ab-interno canaloplasty standalone versus combined with cataract surgery for the treatment of open-angle glaucoma. Ophthalmol Glaucoma. 2022 Feb 17:S2589-4196(22)00025 – 4.Khaimi, M. A., Dvorak, J. D., & Ding, K. (2017). An analysis of 3‑year outcomes following canaloplasty for the treatment of open-angle glaucoma. Journal of ophthalmology, 2017.Gallardo MJ, Supnet RA, Ahmed IIK. Viscodilation of Schlemm’s canal for the reduction of IOP via an ab-interno approach. Clinical Ophthalmology. Vol 12. August 2018.
Gallardo, MJ. 24-Month Efficacy of Viscodilation of Schlemm’s Canal and the Distal Outflow System with iTrack Ab-Interno Canaloplasty for the Treatment of Primary Open-Angle Glaucoma. Clinical Ophthalmology 2021:151591 –1599.
Kazerounian S, Zimbelmann M, Lörtscher M, et al. Canaloplasty ab interno (AbiC) — 2 Year-Results of a Novel Minimally Invasive Glaucoma Surgery (MIGS) Technique. Klinische Monatsblatter fur Augenheilkunde. 2020 Nov. DOI: 10.1055/a 1250 – 8431.
D.M. Lubeck, MD, and R.J. Noecker, MD, unpublished data, 2020; accepted for presentation at ASCRS2021.
Manik Goel, Renata G Picciani, Richard K Lee, and Sanjoy K Bhattacharya. Aqueous Humor Dynamics: A Review. Open Ophthalmol J. 2010; 4: 52 – 59.
Johnstone MA, Grant WG. Pressure-dependent changes in structures of the aqueous outflow system of human and monkey eyes. Am J Ophthalmol. 1973;75:365 – 383
Allingham RR, de Kater AW, Ethier CR. Schlemm’s canal and primary open angle glaucoma: correlation between Schlemm’s canal dimensions and outflow facility. Exp Eye Res. 1996;62(1):101 – 109.
Gong H, et al. Reduction of the available area for Aqueous humor outflow and increase in meshwork herniations into collector channels following acute IOP elevation in bovine eyes. Invest. Ophthalmol Vis Sci 2008; 49:5346 –5352.
Gong H and Francis A: Schlemm’s Canal and Collector Channels as Therapeutic Targets. In Innovations in Glaucoma Surgery, Samples JR and Ahmed I eds. Chapter 1, page 3 – 25, Springer New York, 2014
Using proprietary microcatheter technology, iTrack™ is a true 360° minimally invasive glaucoma surgery (MIGS) that addresses the entire conventional outflow pathway, including the trabecular meshwork, Schlemm’s canal and the collector channels. It does not remove or damage tissue and does not require a permanent stent or implant. As an added benefit, iTrack™ is cleared for use as a standalone procedure and in combination with cataract surgery.
Stent-Free MIGS Procedure
30% average IOP reduction
Standalone or Combined Procedure
What does iTrack™ do differently to other MIGS devices?
Rather than attempt to mechanically change or bypass the pathway of aqueous outflow, iTrack™ acts to re-establish the natural aqueous flow throughout 360° of the conventional outflow pathway. Akin to angioplasty of the eye, iTrack™ combines a process of catheterization and viscodilation to address all potential points of blockage in the trabecular meshwork, Schlemm’s canal and the collector channels.
iTrack™ comprehensively treats outflow locations, which is why it is my first go-to MIGS procedure. I don’t have the diagnostic capability to know where the obstruction is located or what level of resistance exists, and so I like to start off with a MIGS that addresses everything.
Up to 75% of the resistance to aqueous humor outflow is localized within the trabecular meshwork.
iTrack™ separates the compressed trabecular plates of the trabecular meshwork and creates microperforations into the anterior chamber.
2
SCHLEMM’S CANAL
Narrow or collapsed Schlemm’s canal correlates with a decrease in outflow facility by as much as 50% in POAG eyes.
iTrack™ mechanically breaks adhesions within Schlemm’s canal and dilates the canal by up to 2 – 3 times via a process of pressurized viscodilation.
3
COLLECTORCHANNELS
Up to 90% of collector channels may be blocked by herniated trabecular meshwork in POAG eyes.
iTrack™ reduces herniations in the collector channels via a process of pressurized viscodilation.
What are the potential benefits of stent-free MIGS?
When it comes to MIGS, preserving tissue is important. So, too, is the ability to preserve natural aqueous flow through the conventional outflow pathway. The use of stent based MIGS, which disrupt natural aqueous flow by attempting to bypass the conventional outflow system via one or more points, create artificial flow. By targeting the entire circumference of the conventional outflow pathway, iTrack™ may limit the risk of ECL. In a 5‑year prospective multi-center study evaluating endothelial cell density (ECD) in eyes undergoing canaloplasty in combination with cataract surgery, interim 12-month results demonstrate a mean change in ECD of ‑3.2% (SD ±9.0%) (D.M. Lubeck, MD, and R.J. Noecker, MD, unpublished data, 2021; accepted for presentation at ASCRS2021).
MIGS stents like iStent and Hydrus Microstent create preferential outflow in one area of the angle, so the same risks seen with traditional incisional glaucoma surgeries may potentially occur with MIGS procedures utilizing stents…
Why should MIGS devices spare, and not tear, the trabecular meshwork?
Glaucoma is a chronic, progressive disease that has no cure. To that end, the preservation of tissue to enable future treatment intervention is an important consideration. iTrack™ uses a combination of 360° catheterization and pressurized viscodilation to reduce IOP, without removing trabecular meshwork tissue. Indeed, iTrack™ preserves both the conjunctiva and angle for future procedures, if required. iTrack™ has also been shown to minimize complications associated with postoperative inflammation.
I view the angle as the new conjunctiva, because I want to manipulate it today – but I also want to preserve tissue. We all know that there’s not a single glaucoma procedure that lasts forever. I want to be able to come back and treat the patient again.
How does iTrack™ outperform the other MIGS devices?
By comprehensively addressing all resistance sites in the conventional outflow pathway, including the collector channel ostia, iTrack™ has demonstrated a mean reduction in IOP at 24 months ranging from 13.2 mmHg when performed as a standalone procedure, to 13.8 mmHg when performed in combination with cataract surgery.1 – 3 It also reduces medication dependence in the majority of patients.1 – 3
Gallardo, MJ. 24-Month Efficacy of Viscodilation of Schlemm’s Canal and the Distal Outflow System with iTrack Ab-Interno Canaloplasty for the Treatment of Primary Open-Angle Glaucoma. Clinical Ophthalmology 2021:151591 –1599.
1. Gallardo, MJ, MD, unpublished data, 2020; accepted for presentation at ASCRS2021.
2. Gallardo, MJ. 24-Month Efficacy of Viscodilation of Schlemm’s Canal and the Distal Outflow System with iTrack Ab-Interno Canaloplasty for the Treatment of Primary Open-Angle Glaucoma. Clinical Ophthalmology 2021:151591 – 1599.
3. Kazerounian S, Zimbelmann M, Lörtscher M, Hommayda S, Tsirkinidou I, Müller M. Canaloplasty ab interno (AbiC) — 2‑Year-Results of a Novel Minimally Invasive Glaucoma Surgery (MIGS) Technique. Klin Monbl Augenheilkd. 2020 Nov 17. English, German. doi: 10.1055/a‑1250 – 8431. Epub ahead of print. PMID: 33202434.
Why is iTrack™ the superior canaloplasty device?
Introduced in 2008 and with more than 150,000 procedures performed globally, iTrack™ is the world’s first canaloplasty microcatheter. It is also the only canaloplasty device that enables surgeons to customize the amount of viscodilation for each patient. Despite measuring just 250 microns, the iTrack™ comprises an infusion pathway for the delivery of ophthalmic viscosurgical device or OVD, a proprietary guidewire that controls how the microcatheter tracks, and a fiber optic for illuminating the distal tip. It also delivers +100 microliters of OVD over the entire 360º of Schlemm’s canal via a process of pressurized viscodilation.
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