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49 Executive Briefing: Minimally Invasive Glaucoma Surgery Technology A degenerative disease, glaucoma is the leading cause of blindness in North America and Europe and is the second leading cause worldwide. It is most often associated with an increase of intraocular pressure (IOP). The most common form of the disease, primary open-angle glaucoma (POAG), is a sight- threatening condition caused by subopti- mal ocular outflow leading to elevated IOP. While conventional surgical interventions such as aqueous shunts and trabeculec- tomy are effective in lowering IOP and are still widely used, they can be associated with numerous intraoperative and postop- erative complications and safety issues. 1,2 Consequently, surgeons are increasingly turning towards non-penetrating, bleb- free, minimally-invasive glaucoma surgery (MIGS) procedures. However, while MIGS procedures appear to be safer than con- ventional surgical interventions, they are not as clinically effective. 3 Ab-interno Canaloplasty is a new MIGS procedure based on time-tested experi- ence with Canaloplasty, a minimally in- vasive, restorative surgical procedure. Canaloplasty has been shown to be both safe and effective in more than 50 peer-re- viewed clinical studies. 4,5 It has also been shown to be equally effective as trabecu- lectomy. 4,5 Offering the clinical efficacy of Canaloplas- ty via a simplified and much faster surgical approach, ab-interno Canaloplasty can be successfully combined with phacoemulsi- fication in order to make best use of time in the operating room. Additionally, ab- interno Canaloplasty restores the function of the eye's natural outflow system without the need for a filtering bleb — offering an unprecedented level of efficacy and safety in the surgical treatment of glaucoma. Unlike trabeculectomy, ab-interno Canalo- plastydoes not produce a filtering bleb. Patients who undergo the procedure can continue normal day-to-day activities di- rectly following treatment and require mini- mal post-operative follow-up. The Ab-interno Canaloplasty Difference Ab-interno Canaloplastyis the only MIGS procedure that successfully and compre- hensively addresses all aspects of po- tential outflow resistance. Like traditional Canaloplasty, ab-interno Canaloplasty tar- gets the trabecular meshwork, Schlemm's canal and collector channels – structures that control ocular outflow. It also follows the same dilation principles of traditional Canaloplasty, where precisely controlled delivery of Healon/Healon GV during with- drawal of the catheter allows the com- pressed tissue planes of the trabecular meshwork to separate, and any herniated inner wall tissue to withdraw from the col- lector channels. It is important to note that Canaloplasty and ab-interno Canaloplasty are the only currently available procedures that address blockages in the collector channels. MIGS procedures lower IOP by address- ing different aspects of (rather than all aspects of) the ocular outflow system. For example, the Trabectome®, uses an elec- trosurgical pulse to ablate the trabecular meshwork and inner wall of Schlemm's canal, while the iStent® works as a tra- becular micro-bypass by allowing aque- ous humor to flow directly from the ante- rior chamber into Schlemm's canal, thus circumventing the trabecular meshwork. 6 In addition to addressing all aspects of ocular outflow, ab-interno Canaloplasty is also fast and easy to perform. The com- bined procedure (phacoemulsification and ab-interno Canaloplasty) is routinely performed in 10 to 15 minutes, with the ab-interno Canaloplasty aspect taking ap- proximately five minutes to perform. Introducing Ab-Interno Canaloplasty: A New Approach to Minimally Invasive Glaucoma Surgery Sponsored by Trabeculectomy, one-day post- operative: bleb Ab-interno Canaloplastyone-day post-operative: no bleb