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

Purpose: This study aimed to evaluate the 24-month efficacy of viscodilation of Schlemm’s canal and the distal outflow system with iTrack ab-interno canaloplasty in reducing intraocular pressure (IOP) and antiglaucoma medication use in patients with primary open-angle glaucoma (POAG). Patients and Methods: This retrospective, comparative, and consecutive case series assessed the 24-month outcomes of iTrack as a standalone procedure (iTrack-alone) or in conjunction with cataract surgery (iTrack+phaco), in cases of mild, moderate or severe POAG. Data were collected at baseline and the 12- and 24-month follow-up visits. Results: The study included 53 patients (60 eyes) with a mean age of 73.6± 9 years. For all eyes, a significant reduction in mean IOP was seen at 12 and 24 months, reducing from 20± 4.9 mmHg at baseline to 13.6± 1.9 mmHg and 13.5± 2.6 mmHg, respectively ( P < 0.001). The reduction in medications was also significant, reducing to 1.12± 1.09 and 1.7± 1.29 medications at 12 months and 24 months, respectively, from a baseline of 2.77± 0.91 ( P < 0.001). Similar results were achieved whether iTrack was performed as a standalone procedure, or in conjunction with cataract surgery. While the iTrack-alone group started with a higher IOP at baseline, both groups experienced similar and stable IOP reduction of more than 30% from baseline. The reduction in medication use was also significant in both groups, decreasing from 3± 0.7 for iTrack-alone and 2.5± 1.1 for iTrack+phaco at baseline to 2.1± 1.3 and 1.3± 1.2 at 24 months, respectively ( P < 0.001). The 24-month efficacy outcomes were similar in cases of mild–moderate versus severe glaucoma. No serious adverse events were recorded. Conclusion: Twenty-four-month follow-up data demonstrate that iTrack ab-interno canaloplasty can effectively reduce IOP and medication dependence, with a good safety profile. These results also demonstrate that iTrack can be effectively performed as a standalone procedure or in combination with cataract surgery, and in all grades of glaucoma severity.