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.
1. 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.
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.
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
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