(1)
Prof. Norbert Körber Augencentrum Köln, Josefstraße 14, 51143 Köln, Germany
Electronic supplementary material
The online version of this chapter (doi:10.1007/978-3-319-47226-3_5) contains supplementary material, which is available to authorized users.
In black patients all fistularising procedures tend to heal aggressively and thereby the success rate is low, even with the use of mitomycin.
Robert Stegmann worked very early with Healon for various indications as ocular trauma, pediatric and senile cataract surgery and glaucoma.
His first studies involved visco-trabeculotomy, which was disappointing as there was scarring of the trabecular meshwork in the trabeculotomy segments and also descemet’s membrane dissection occurred frequently.
Thus, he developed viscocanalostomy and later canaloplasty as a logical step to improve the results.
Viscocanalostomy showed good long term results in a long term follow up study for black as well as for Caucasian patients.
Canaloplasty is effective on a long term base as well, as the international multicenter study could show.
In Europe, canaloplasty was performed for the first time in 2005 in three surgical centers in Germany (v.Wolffand Bull; Tetz; Koerber) and one in the UK (C.Peckar).
Since then, canaloplasty has been adopted by numerous surgeons in Europe. In Germany, it is coded in the DRG system and in the public health system. Thus, we can state, that this operation has been accepted officially. This year, a patient association named canaloplasty as the new gold standard in glaucoma surgery, as this operation offers good results with a low risk profile.
Viscocanalostomy
The Surgery Step-by-Step
Viscocanalostomy is performed according to Stegmann’s15 technique, with the creation of a parabolic 5 × 5 mm limbal-based one-third scleral thickness flap (Figs. 5.1 and 5.2). With the goal of achieving a watertight closure, cautery is avoided and 1:10,000 epinephrine is applied using a Weck-cel sponge to achieve hemostasis (Fig. 5.3). A deep scleral flap is created 0.5 mm inside the superficial flap, dissecting down until the choroid is just visible. Schlemm’s canal is unroofed and a membrane is cleaved from the cornea, creating a Descemetic window through which aqueous can permeate (Fig. 5.4). The inner, deep scleral flap is then excised, forming the scleral lake (Fig. 5.5). The two surgically created ostia of Schlemm’s canal are injected six times with Healon™ GV (Abbott Medical Optics, Santa Ana, California) using a 150 μm cannula (ViscoCanalostomy Cannula, Grieshaber, Schaffhausen, Switzerland) (Fig. 5.6).
Fig. 5.1
Opening of the conjunctiva
Fig. 5.2
First flap
Fig. 5.3
Compression of sclera with suprarenine
Fig. 5.4
Preparation of the inner flap – descemet window
