# Modified suture-assisted penetrating canaloplasty vs. compound trabeculectomy in treating primary angle-closure glaucoma

## TL;DR

A modified suture-assisted canaloplasty was found to be more effective than traditional surgery for angle-closure glaucoma, reducing eye pressure and medication use with fewer complications.

## Contribution

The study introduces a modified suture-assisted penetrating canaloplasty technique that outperforms compound trabeculectomy in treating PACG.

## Key findings

- Modified SAPC achieved significantly lower intraocular pressure (12.38 mmHg) compared to compound trabeculectomy (16.82 mmHg) at 12 months.
- Modified SAPC had a higher complete success rate (89.47%) than compound trabeculectomy (52.94%).
- The modified SAPC technique reduced medication dependence and had fewer complications.

## Abstract

To evaluate the effectiveness and safety of a modified suture-assisted penetrating canaloplasty (SAPC) compared to compound trabeculectomy for treating primary angle-closure glaucoma (PACG).

Retrospective comparative interventional study.

We analyzed consecutive cases of uncontrolled PACG treated at Fuzhou Eye Hospital (December 2019-April 2021) with either modified SAPC (study group) or compound trabeculectomy (control group). Postoperative evaluations occurred at 1 week and 1, 3, 6, and 12 months. Outcome measures included mean diurnal intraocular pressure (mdIOP), anti-glaucoma medication burden, surgical success rate (complete: mdIOP ≤18 mmHg without medications; qualified: mdIOP ≤18 mmHg with medications), and complications.

The final analysis included 19 eyes in the modified SAPC group and 17 eyes in the control group. At the 12-month follow-up, the SAPC group demonstrated a significant reduction in mdIOP from 20.17±6.00 mmHg to 12.38±2.60 mmHg (P<0.001), with medications reduced from 3.21±1.03 to 0.11±0.32 (P<0.001). Compared to the control group's mdIOP of 16.82±2.36 mmHg with 0.43±0.68 medications at 12 months, the modified SAPC group maintained significantly better pressure control (P<0.001). The complete success rate was substantially higher in the SAPC group (89.47% vs. 52.94%, P=0.038). Transient IOP elevation occurred in 5 eyes (26.3%) following SAPC, representing the most frequent postoperative complication. No significant vision loss or serious adverse events were observed.

Modified SAPC provides effective and sustained IOP reduction with a favorable safety profile, outperforming compound trabeculectomy in PACG patients over 12 months. while minimizing medication dependence, demonstrating superior effectiveness to compound trabeculectomy with a favorable short-term safety profile.

Why carry out this study?

This study aimed to evaluate the effectiveness and safety of a modified suture-assisted penetrating canaloplasty (SAPC) technique compared to compound trabeculectomy in treating primary angle-closure glaucoma (PACG).This study addressed the limitations of high-cost microcatheters and bleb-related complications.

This study aimed to evaluate the effectiveness and safety of a modified suture-assisted penetrating canaloplasty (SAPC) technique compared to compound trabeculectomy in treating primary angle-closure glaucoma (PACG).

This study addressed the limitations of high-cost microcatheters and bleb-related complications.

What was learned from the study?

Modified SAPC demonstrated superior intraocular pressure (IOP) reduction (12.38±2.60 mmHg vs. 16.82±2.36 mmHg at 12 months) and higher complete success rates (89.47% vs. 52.94%) compared to compound trabeculectomy, with fewer complications and reduced dependence on postoperative medications.The technique’s cost-effective use of 5-0 polypropylene sutures and adjustable sutures simplified the procedure while maintaining high catheterization success (87.5%), offering a viable alternative for mild-to-moderate PACG.Younger patients with short axial lengths showed an increased risk of malignant glaucoma post-SAPC, highlighting the need for refined surgical approaches in this subgroup.

Modified SAPC demonstrated superior intraocular pressure (IOP) reduction (12.38±2.60 mmHg vs. 16.82±2.36 mmHg at 12 months) and higher complete success rates (89.47% vs. 52.94%) compared to compound trabeculectomy, with fewer complications and reduced dependence on postoperative medications.

The technique’s cost-effective use of 5-0 polypropylene sutures and adjustable sutures simplified the procedure while maintaining high catheterization success (87.5%), offering a viable alternative for mild-to-moderate PACG.

Younger patients with short axial lengths showed an increased risk of malignant glaucoma post-SAPC, highlighting the need for refined surgical approaches in this subgroup.