Purposes To evaluate the effectiveness and safety of a modified suture-assisted penetrating canaloplasty (SAPC) compared to compound trabeculectomy for treating primary angle-closure glaucoma (PACG). Design Retrospective comparative interventional study. Methods We analyzed consecutive cases of uncontrolled PACG treated at Fuzhou Eye Hospital (December 2019-April 2021) with either modified SAPC (study group) or compound trabeculectomy (control group). Postoperative evaluations occurred at 1 week and 1, 3, 6, and 12 months. Outcome measures included mean diurnal intraocular pressure (mdIOP), anti-glaucoma medication burden, surgical success rate (complete: mdIOP ≤18 mmHg without medications; qualified: mdIOP ≤18 mmHg with medications), and complications. Results The final analysis included 19 eyes in the modified SAPC group and 17 eyes in the control group. At the 12-month follow-up, the SAPC group demonstrated a significant reduction in mdIOP from 20.17±6.00 mmHg to 12.38±2.60 mmHg (P<0.001), with medications reduced from 3.21±1.03 to 0.11±0.32 (P<0.001). Compared to the control group's mdIOP of 16.82±2.36 mmHg with 0.43±0.68 medications at 12 months, the modified SAPC group maintained significantly better pressure control (P<0.001). The complete success rate was substantially higher in the SAPC group (89.47% vs. 52.94%, P=0.038). Transient IOP elevation occurred in 5 eyes (26.3%) following SAPC, representing the most frequent postoperative complication. No significant vision loss or serious adverse events were observed. Conclusion Modified SAPC provides effective and sustained IOP reduction with a favorable safety profile, outperforming compound trabeculectomy in PACG patients over 12 months. while minimizing medication dependence, demonstrating superior effectiveness to compound trabeculectomy with a favorable short-term safety profile. Key Summary Points Why carry out this study? <OrderedList> <ListItem> <ItemNumber>1.</ItemNumber> <ItemContent> This study aimed to evaluate the effectiveness and safety of a modified suture-assisted penetrating canaloplasty (SAPC) technique compared to compound trabeculectomy in treating primary angle-closure glaucoma (PACG). </ItemContent> </ListItem> <ListItem> <ItemNumber>2.</ItemNumber> <ItemContent> This study addressed the limitations of high-cost microcatheters and bleb-related complications. </ItemContent> </ListItem> </OrderedList> What was learned from the study? <OrderedList> <ListItem> <ItemNumber>1.</ItemNumber> <ItemContent> Modified SAPC demonstrated superior intraocular pressure (IOP) reduction (12.38±2.60 mmHg vs. 16.82±2.36 mmHg at 12 months) and higher complete success rates (89.47% vs. 52.94%) compared to compound trabeculectomy, with fewer complications and reduced dependence on postoperative medications. </ItemContent> </ListItem> <ListItem> <ItemNumber>2.</ItemNumber> <ItemContent> The technique’s cost-effective use of 5-0 polypropylene sutures and adjustable sutures simplified the procedure while maintaining high catheterization success (87.5%), offering a viable alternative for mild-to-moderate PACG. </ItemContent> </ListItem> <ListItem> <ItemNumber>3.</ItemNumber> <ItemContent> Younger patients with short axial lengths showed an increased risk of malignant glaucoma post-SAPC, highlighting the need for refined surgical approaches in this subgroup. </ItemContent> </ListItem> </OrderedList>

Modified suture-assisted penetrating canaloplasty vs. compound trabeculectomy in treating primary angle-closure glaucoma

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2025年10月21日

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Jianhui Zhang,
Ningning Lin,
Liu Zhang,
Shancheng Si

摘要

Purposes

To evaluate the effectiveness and safety of a modified suture-assisted penetrating canaloplasty (SAPC) compared to compound trabeculectomy for treating primary angle-closure glaucoma (PACG).

Design

Retrospective comparative interventional study.

Methods

We analyzed consecutive cases of uncontrolled PACG treated at Fuzhou Eye Hospital (December 2019-April 2021) with either modified SAPC (study group) or compound trabeculectomy (control group). Postoperative evaluations occurred at 1 week and 1, 3, 6, and 12 months. Outcome measures included mean diurnal intraocular pressure (mdIOP), anti-glaucoma medication burden, surgical success rate (complete: mdIOP ≤18 mmHg without medications; qualified: mdIOP ≤18 mmHg with medications), and complications.

Results

The final analysis included 19 eyes in the modified SAPC group and 17 eyes in the control group. At the 12-month follow-up, the SAPC group demonstrated a significant reduction in mdIOP from 20.17±6.00 mmHg to 12.38±2.60 mmHg (P<0.001), with medications reduced from 3.21±1.03 to 0.11±0.32 (P<0.001). Compared to the control group's mdIOP of 16.82±2.36 mmHg with 0.43±0.68 medications at 12 months, the modified SAPC group maintained significantly better pressure control (P<0.001). The complete success rate was substantially higher in the SAPC group (89.47% vs. 52.94%, P=0.038). Transient IOP elevation occurred in 5 eyes (26.3%) following SAPC, representing the most frequent postoperative complication. No significant vision loss or serious adverse events were observed.

Conclusion

Modified SAPC provides effective and sustained IOP reduction with a favorable safety profile, outperforming compound trabeculectomy in PACG patients over 12 months. while minimizing medication dependence, demonstrating superior effectiveness to compound trabeculectomy with a favorable short-term safety profile.

Key Summary Points

Why carry out this study?

This study aimed to evaluate the effectiveness and safety of a modified suture-assisted penetrating canaloplasty (SAPC) technique compared to compound trabeculectomy in treating primary angle-closure glaucoma (PACG).

This study addressed the limitations of high-cost microcatheters and bleb-related complications.

What was learned from the study?

Modified SAPC demonstrated superior intraocular pressure (IOP) reduction (12.38±2.60 mmHg vs. 16.82±2.36 mmHg at 12 months) and higher complete success rates (89.47% vs. 52.94%) compared to compound trabeculectomy, with fewer complications and reduced dependence on postoperative medications.

The technique’s cost-effective use of 5-0 polypropylene sutures and adjustable sutures simplified the procedure while maintaining high catheterization success (87.5%), offering a viable alternative for mild-to-moderate PACG.

Younger patients with short axial lengths showed an increased risk of malignant glaucoma post-SAPC, highlighting the need for refined surgical approaches in this subgroup.