Comparing Canaloplasty and a Trabecular Micro-Bypass Stent

In this episode, Dr. Goldberg discussed interim results from the ongoing VENICE study, which compares canaloplasty outcomes with the STREAMLINE Surgical System (New World Medical) and iStent inject W (Glaukos) in patients with primary open-angle glaucoma.¹

The randomized, multicenter, controlled trial evaluated safety and efficacy outcomes in 72 eyes. Following pre- and post-medication washout visits, one eye per subject was were randomized on a 1-to-1 basis to either STREAMLINE (n = 35) or iStent inject W (n = 37) following phacoemulsification. Eligible patients were evaluated on day 1 and week 1, and at months 1, 3, and 6 for IOP, number of IOP-lowering medications, and adverse events.

Results demonstrated an initial pressure response from both technologies on day 1 postoperatively, which remained the same for about a year (Figure 1).¹ When examining medication use at 6 months, about 81% of STREAMLINE patients were able to taper off their medication, with iStent inject W patients exhibiting equally effective results at about 78% (Figure 2).¹

Safety data showed that adverse events were generally mild and self-limited. In this population of patients:

• Two eyes (one STREAMLINE, one iStent inject W) had early mild corneal edema with transiently elevated IOP; each resolved with short-term use of topical therapeutics.
• One eye (STREAMLINE) had late corneal edema with elevated IOP, which resolved with short-term use of topical therapeutics.
• Two eyes (one STREAMLINE, one iStent inject W) had early elevated IOP; each resolved without sequelae after paracentesis tap and topical medications.
• Four eyes (STREAMLINE) had cell and flare 4 to 9 weeks after surgery; these were deemed unrelated to the STREAMLINE device or surgery.
• One eye (STREAMLINE) had blood in the angle at postoperative day 1.
• One eye (iStent inject W) had mild cystoid macular edema, which resolved with topical treatment.

Overall, these interim findings demonstrated comparable IOP and medication reduction between STREAMLINE canaloplasty and iStent inject W implantation when combined with phacoemulsification.

“We're going to keep following these patients to see what [else we can learn],” said Dr. Goldberg. “It's great that we have several technologies that seem to work well, and we can offer these patients a new type of technique for pressure reduction.”