Canaloplasty and Goniotomy

MIGS procedures are designed to reduce eye pressure with tiny incisions and minimal tissue disruption. They often allow patients to use fewer daily eye drops while maintaining good long-term safety.

Glaucoma develops when fluid cannot drain properly through the trabecular meshwork and Schlemm’s canal. The resulting pressure damages the optic nerve and can lead to vision loss if untreated.

Canaloplasty threads a flexible microcatheter through Schlemm’s canal, enlarging it so fluid flows more freely and pressure drops.

The surgeon makes a small incision, guides the microcatheter around the full 360 degrees of Schlemm’s canal, and uses a gel to expand the channel. A tension suture may be placed to keep the canal open, and no implant remains in the eye.

• Small corneal incision
• 250-micron microcatheter passes through Schlemm’s canal
• Viscoelastic gel enlarges the canal
• Optional tension suture maintains canal opening
• No permanent implant left behind

Goniotomy creates openings in the trabecular meshwork so fluid can exit the eye more easily, lowering internal pressure.

Tiny corneal incisions are made, a goniolens provides a clear view, and specialized instruments cut or remove parts of the trabecular meshwork to form new drainage channels.

• Small corneal incisions
• Goniolens aids visualization
• Precision instruments excise or incise tissue
• Procedure takes about 20 to 30 minutes

Several devices assist surgeons in performing canaloplasty and goniotomy safely and effectively.

• iTrack Microcatheter and iTrack Advance for 360-degree canal dilation
• Trabectome for electrosurgical removal of trabecular meshwork
• TrabEx and TrabEx Plus with serrated blades for tissue excision
• Kahook Dual Blade designed for complete meshwork removal
• OMNI Surgical System, an FDA-approved device able to perform both canaloplasty and goniotomy in one surgery

Preparation ensures a smooth procedure and recovery.

• Comprehensive eye exam and pressure check
• Medical clearance and review of existing medications
• Instructions on fasting and arranging transportation home

The outpatient procedure is done under local anesthesia with light sedation.

• Tiny corneal incision under a surgical microscope
• Procedure lasts 20 to 30 minutes for MIGS alone
• Longer time if combined with cataract surgery
• Patients may see bright lights but feel no pain

Most patients go home the same day with a protective shield over the eye.

• Mild discomfort, blurred vision, and light sensitivity are common
• Shield worn during sleep for one week

Initial healing focuses on comfort and protection.

• Mild scratchiness, watery eyes, or blurred vision
• Wear the eye shield while sleeping
• Rest with head elevated and use sunglasses outdoors

Vision begins to sharpen, but activity limits remain.

• Use prescribed antibiotic and steroid drops on schedule
• No bending past the waist or heavy lifting
• Avoid vigorous exercise, dusty areas, and eye rubbing
• Light computer work and reading are usually fine

Most patients return to normal routines during this period.

• Vision typically equals or exceeds pre-surgery levels
• Eye makeup and contact lenses may resume after two weeks if approved
• Light workouts restart after two weeks; swimming and contact sports after four weeks
• Driving allowed once visual acuity meets legal standards

Regular visits confirm that healing is on track and pressure stays controlled.

• Day 1: pressure check and incision review
• Week 1: assess vision and adjust medications
• Month 1: confirm stable pressure and taper drops
• Additional visits as part of ongoing glaucoma care

The procedures are considered very safe, yet any surgery carries some risk.

• Common and temporary: small blood spot, brief pressure rise, mild irritation
• Less common: early cataract development, persistent high pressure, need for touch-up surgery
• Rare but serious: infection, severe vision loss, damage to surrounding structures