Recommendations for ab-interno canaloplasty in glaucoma management: expert consensus on treatment protocols and outcomes

Background Ab-interno canaloplasty (ABiC), a trabecular outflow-enhancing minimally invasive glaucoma surgery (MIGS), reduces intraocular pressure (IOP) and medications in open-angle glaucoma (OAG). However, evidence on optimal use-cases and surgical/post-surgical protocols is limited. This study explores expert opinions on best practices in ABiC.Research design and methods A modified Delphi method (Round 1: web-based, Round 2: face-to-face, Round 3: web-based) generated consensus on indications, surgical protocol, postoperative management, and expected outcomes from a national panel of 6 glaucoma surgeons experienced with ABiC using iTrack (Nova Eye Medical). Consensus was predefined as minimum two-thirds of the panelists selecting ‘Strongly Agree/Agree’ for Round 3 Likert-scale statements.Results All statements achieved consensus in Round 3 (100% response rate). Expert opinion was that ABiC is ideal in mild–moderate and stable severe OAG; effective with/without concomitant phacoemulsification; typically performed circumferentially with 100–148 µL of pressurized viscoelastic delivery; followed routinely with antibiotic and steroid drops; associated with transient complications like hyphema and IOP spikes; expected to demonstrate efficacy up to 5 years; and amenable to subsequent MIGS/invasive surgery.Conclusions This exploratory consensus study represents an initial effort toward formulating best practices in ABiC. Delphi studies with large, diverse panels are required to establish robustly generalizable practice guidelines.