title: A modified scleral dissection technique with suprachoroidal drainage for canaloplasty.
abstract: OBJECTIVE
  A modified canaloplasty technique is described that may facilitate the surgical procedure and potentially maximizes the intraocular pressure (IOP)-lowering effect by altering both the trabecular and uveoscleral aqueous outflow.
  
  
  METHODS
  The second deeper layer in the modified technique (about 3.5 × 4 mm, Fig. 1a, b) is not prepared in a lamellar fashion, but is cut down full-thickness to the choroid, hence opening the suprachoroidal space. Furthermore, this second deep scleral flap creates an additional aqueous outflow and drainage into the suprachoroidal space, thus possibly lowering the postoperative IOP by improving the natural uveoscleral outflow facility.
  
  
  RESULTS
  Seventy-eight eyes operated with this modified technique in the last 12 months were retrospectively analysed. Mean IOP before surgery was 19.10 mmHg and patients applied 3.0 topical medications. Twelve months after surgery, the IOP was 13.5 mmHg and patients applied 1.0 topical medication; 52.6 % of patients did not use any topical therapy.
  
  
  CONCLUSIONS
  The modified dissection canaloplasty technique potentially improves the IOP-lowering effect due to the creation of additional suprachoroidal drainage and simplifies the most complicated step of the surgery, as the scleral spur and the Schlemm's canal can be located using suprachoroidal access.
authors.affiliation: Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, An der Klinik 10, 66280, Sulzbach, Saar, Germany.|Centre for Ophthalmology, University Eye Clinic Tuebingen, Tuebingen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Szurman
authors.affiliation: Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, An der Klinik 10, 66280, Sulzbach, Saar, Germany.|Centre for Ophthalmology, University Eye Clinic Tuebingen, Tuebingen, Germany.
authors.forename: Kai
authors.initials: K
authors.lastname: Januschowski
authors.affiliation: Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, An der Klinik 10, 66280, Sulzbach, Saar, Germany. drkarlboden@googlemail.com.
authors.forename: Karl Thomas
authors.initials: KT
authors.lastname: Boden
authors.affiliation: Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, An der Klinik 10, 66280, Sulzbach, Saar, Germany.|Centre for Ophthalmology, University Eye Clinic Tuebingen, Tuebingen, Germany.
authors.forename: Gesine Bettina
authors.initials: GB
authors.lastname: Szurman
mesh_terms: D001082:Aqueous Humor / Q000378:metabolism*; D002829:Choroid / Q000378:metabolism*; D004210:Dissection; D004322:Drainage / Q000379:methods*; D018463:Filtering Surgery / Q000379:methods*; D005901:Glaucoma / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D019919:Prosthesis Implantation / Q000379:methods; D012189:Retrospective Studies; D012590:Sclera / Q000601:surgery*; D013524:Surgical Flaps; D013536:Suture Techniques
keywords: Canaloplasty; Modified technique; Novel canaloplasty technique; Schlemm’s canal preparation