Background/Aims To study the safety and effectiveness of 360° viscodilation and tensioning of Schlemm canal (canaloplasty) in black African patients with primary open-angle glaucoma (POAG).

Methods Sixty randomly selected eyes of 60 consecutive patients with POAG were included in this prospective study. Canaloplasty comprised 360° catheterisation of Schlemm's canal by means of a flexible microcatheter with distension of the canal by a tensioning 10-0 polypropylene suture.

Results The mean preoperative intraocular pressure pressure (IOP) was 45.0±12.1 mm Hg. The mean follow-up time was 30.6±8.4 months. The mean IOP at 12 months was 15.4±5.2 mm Hg (n=54), at 24 months 16.3±4.2 mm Hg (n=51) and at 36 months 13.3±1.7 mm Hg (n=49). For IOP ≤21 mm Hg, complete success rate was 77.5% and qualified success rate was 81.6% at 36 months. Cox regression analysis showed that preoperative IOP (HR=1.003, 95% CI=0.927 to 1.085; p=0.94), age (HR=1.000, CI=0.938 to 1.067; p=0.98) and sex (HR=3.005, CI=0.329 to 27.448; p=0.33) were all not significant predictors of IOP reduction to ≤21 mm Hg. Complication rate was low (Descemet's detachment n=2, elevated IOP n=1, false passage of the catheter n=2).

Conclusion Canaloplasty produced a sustained long-term reduction of IOP in black Africans with POAG independent of preoperative IOP. As a bleb-independent procedure, canaloplasty may be a true alternative to classic filtering surgery, in particular in patients with enhanced wound healing and scar formation.