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Editors Selection IGR 10-4

Surgical Treatment: Imaging aqueous outflow system

Comment by Andreas Boehm on:

23873 Channelography: imaging of the aqueous outflow pathway with flexible microcatheter and fluorescein in canaloplasty, Grieshaber MC; Pienaar A; Olivier J et al., Klinische Monatsblätter für Augenheilkunde, 2009; 226: 245-248

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In the paper by Grieshaber et al. (898) a new in vivo imaging technique visualizing the aqueous outflow system is introduced. During canaloplasty, a new non-penetrating glaucoma surgery claiming to restore internal aqueous outflow, a flexible microcatheter is inserted into Schlemm's canal and diluted fluorescein is injected through the microcatheter. After injection the fluorescein can be visualized in the episcleral veins and in the AC due to retrograde diffusion. The authors observed differences between the eight patients examined with glaucoma, in whom canaloplasty was performed.

It is interesting to visualize the aqeous outflow in vivo. However, as this method is invasive and the microcatheter is expensive, the technique will only be applicable to patients in whom trabeculoplasty is performed. Regarding the success of trabeculoplasty, in the authors' opinion, the integrity of the aqueous outflow pathway is necessary, and they hypothesize that this technique could provide potentially crucial information on whether canaloplasty will be successful or not. However, many questions remain unsolved: 1. The technique is not standardized. 2. There was no control group. Therefore, we do not know whether the observed differences are caused by differences in the aqueous outflow pathway or by other reasons. Further studies are needed to clarify whether the fluorescein filling in the episcleral veins and the retrograde diffusion in AC are different between normals and glaucoma patients, and whether these parameters are related to the surgical outcome.

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