1. Frolov Mikhail, Dushina Galina
Ab externo Schlemm’s canal surgery in management of open angle glaucoma
Kumar Vinod
Frolov Mikhail, Dushina Galina
Ophthalmic unit of Skhodnya city hospital, Moscow province, Russian Federation; Department of ophthalmology, Medical Institute of People’s friendship university of Russia, Moscow
Financial disclosure – People’s friendship university of Russia is the patent holder of the device
ESCRS-2015
Barcelona

2. Introduction Kumar’s 1st generation Schlemm’s canal expander (SCE)
Length - 5-6mm long; outer diameter - .3mm; inner diameter - .2mm
Schematic representation and actual size of Kumar’s 1st generation SCE
reduction in mean IOP by 46%
Complete success – 41.7% cases
Partial success – 58.3% cases
Disadvantages:
size not appropriate for all cases
implantation required repeated SC dilation
Traumatic to SC structures implantation
Russian patent of useful model № – dated

3. Kumar’s 2nd generation SCE
Device was made from 0.04mm thick medical grade soft vanadium stainless steel wire by winding it on a 0.12 mm thick stainless steel microprobe having curvature as of SC.
Measurements: length -3.0 mm; inner lumen diameter - .12mm; outer - .2mm.
Natural size of 1st generation SCE
Natural size of 2nd generation SCE
2nd generation SCE
in comparison to
1 kopek coin
Purpose: To evaluate the effectiveness of segmental Schlemm’s canal (SC) distension using Kumar’s 2nd generation stainless steel spiral Schlemm’s canal expander (SCE) in decreasing intraocular pressure (IOP) in patients with open angle glaucoma (OAG).

4. Methods and material
Design: Uncontrolled, non-randomized, interventional case
series.
Total 13 cases (13 eyes): Male –9 (69.2%), female – 4(30.8%); avg.
age: 71.2+/-1.7 yrs.
Study period: June 2013 – Feb 2015.
Exclusion criteria: Angle closure glaucoma and cases with crowded
angle; minimum follow up less than 12 months
Main outcome measures: IOP change, complication rate, additional
glaucoma medication, need for surgical revision.
Criteria for success : Complete success - decrease in IOP >20% or IOP
18 mmHg or less without medication
Partial success - decrease in IOP >20% or IOP
18 mmHg or less with medication
Failure - cases requiring 2nd surgery
A paired t-test was used for analysis. Results were significant when p less than .05

5. Surgical technique of implantation of 2nd generation SCE

6. Mean IOP after implantation of 2nd generation SCE
SCE-2: at 12 months mean IOP decreased by 44.5+/-12.8% (n=12; 95% CI )
SCE-1: at 12 months mean IOP decreased by 49.8+/-15.3% (n=10; 95% CI )

7. Mean postoperative IOP after 2nd generation SCE
reduction
18mmHg
6mmHg

8. Mean number of hypotensive medications

9. Success rate Follow up 6 months 12 months Success SCE-1 SCE-2 P p
Complete
72.2%
41.7%
0.004
60%
0,069
Partial
27.8%
58.3%
0.001
40%
0.065
Failure

10. Results Easy to implant No need for mechanical dilation of canal
SCE-1
SCE-2
SCE-2
Observations during surgery:
Micro-perforation of TM
SCE-2: % (2/13) cases
SCE-1: % (3/18) cases
Observations in postoperative period:
YAG laser trabeculpuncture
SCE-2: 25% (3/12) cases
SCE-1: 6% (1/18) cases
Easy to implant
No need for mechanical dilation of canal
Early rehabilitation
No cases of hypotony, endophthalmitis, or shallow AC
Not a single case of inflammation at insertion site

11. Kumar’s 3rd generation Schlemm’s canal expander
Discussion:
By reducing the size of the device we got the following advantages of the new model:
Insertion of the device into SC became more easier and less traumatic as no mechanical dilation of SC is required.
Disadvantages of new model:
1. Length of distended? segment of SC is reduced by 50%, which may be reason for less number of cases with complete success.
2. SC may not be well distended resulting in need of more YAG laser trabeculopuncture in early postoperative period.
Conclusions:
Though results of SCE-2 insertion in surgical management of OAG show significant reduction in IOP from the baseline and in hypotensive medication(s) use, the reduced size may not be the appropriate one, as it does not distend the SC well enough to ensure high number of complete success cases.
Kumar’s 3rd generation Schlemm’s canal expander
5mm in length, inner diameter-.15mm, outer diameter .25mm

12. Thanks