ABiC, Ab Interno Canaloplasty

ABiC™ is a new, comprehensive MIGS procedure. Performed via a self-sealing, clear corneal incision, ABiC™ conserves the clinically proven benefits of 360-degree viscodilation of Schlemm’s canal provided by traditional Canaloplasty, but with the speed and ease of implementation of an MIGS procedure. Unlike other currently available MIGS procedures, however, ABiC™ preserves tissue and does not require permanent placement of an implant in the eye. It has also been shown to be effective as both a stand-alone procedure and as a combined procedure performed in conjunction with cataract surgery.

ABiC: Clinical Footage
Mark J. Gallardo, MD
EL Paso Eye Surgeons, USA

Unedited video of ABiC in a phakic patient with primary open-angle glaucoma. During the procedure, Goniotomy, 360° cannulation and visco-dilation of Schlemm’s canal with the iTrack microcatheter are performed. Once the distal end has circumnavigated to the point of entry the iTrack is slowly withdrawn, while Healon/Healon GV is emitted upon single clicks of the visco-injector knob.

ABiC: According to the Expert
Mark J. Gallardo, MD
EL Paso Eye Surgeons, USA

According to ABiC expert Mark J. Gallardo, MD, to become a successful ABiC surgeon, one must properly ensure good visualization of the nasal drainage angle. The temporal clear corneal wound should be made directly across from the nasal angle, and side port incisions should be 90º from this angle. Corneal incisions should avoid the limbal vessels as much as possible, as surface bleeding can stain the viscoelastic used as a coupling agent for the gonioscopy lens and hinder the view to the drainage angle. Watch this instructional video to learn more.

ABiC: Restoring the Natural Pathway
Mahmoud A. Khaimi, MD
Dean McGee Eye Institute, USA

One of the challenges associated with the use of stent-based MIGS is that the location of increased aqueous outflow resistance is often unclear: when targeting a small area of the outflow system only there is a risk that the area of blockage will be missed or sub optimally treated. A comprehensive MIGS procedure, ABiC™ accesses, catheterizes, and viscodilates the trabecular meshwork, Schlemm’s canal, and importantly, the distal outflow system, beginning with the collector channels – thus addressing all aspects of potential outflow resistance.

ABiC: Clinical Footage (Stand-Alone Procedure)
Mahmoud A. Khaimi, MD
Dean McGee Eye Institute, USA

According to Dr. Khaimi, ABiC can be performed in three easy steps.
“First, I perform a clear temporal incision approximately 1.8 mm-wide. I then inject an OVD into the anterior chamber in order to maintain stability. Next, I place the iTrack microcatheter into anterior chamber in preparation for insertion into Schlemm’s canal. I then use a 27-gauge needle and perform a small goniotomy, before placing the iTrack into Schlemm’s canal and advancing it 360-degrees. I then pull the iTrack out and viscodilate. I typically get 15-20 clicks. It is important to note that this is a fair bit more viscodilation than with traditional Canaloplasty, made possible by the fact that we first use an OVD to maintain stability.”

  • FDA approved
  • Comprehensive: treats trabecular meshwork, Schlemm’s canal and collector channels
  • No permanent implant or stent
  • Can be performed both with and without cataract surgery
  • 12-month case series results demonstrate an average IOP reduction of 30% and a 50% reduction in medication burden

Removing the Guesswork from MIGS

The most defining aspect of ABiC™ is its comprehensive approach. To date, ABiC™ is the only MIGS procedure that successfully and comprehensively addresses all aspects of potential outflow resistance. Whereas other MIGS procedures treat only one aspect of aqueous outflow, ABiC™ comprehensively accesses, catheterizes, and viscodilates the trabecular meshwork, Schlemm’s canal, and importantly, the distal outflow system, beginning with the collector channels.

The Only MIGS Procedure Performed Outside Cataract Surgery in the USA

Performed via a self-sealing, clear corneal incision, ABiC™ can be combined with cataract surgery in order to optimize time in the operating room, or performed as a stand-alone procedure. To date, ABiC is the only MIGS procedure approved for use outside cataract surgery in the USA. Based on a 228-eye case series by Mark J. Gallardo, MD (El Paso Eye Surgeons, PA) and Mahmoud A. Khaimi, MD (Dean McGee Eye Institute, OK), ABiC achieved a 36.74% reduction in IOP at 12 months (21.5 ± 7.4 mm Hg at baseline to 13.6 ± 1.20 mm Hg).

Physiological Outflow PathwayNon-Physiological Pathway
Collector ChannelsTrabecular MeshworkSchlemm’s CanalSubconjunctival SpaceSupraciliary space
ABiC YESYESYES
iStentYES
CyPass MicrostentYES
XEN Gel StentYES

iTRACK™ Microcatheter

Featuring a proprietary design, iTrack™ is the only illuminated, micron-scale microcatheter designed to viscodilate Schlemm’s canal during MIGS with ABiC. The stand-out feature of the iTrack™ is its illuminated tip, which allows you to monitor its location at all times to ensure you do not enter any of the collector channel ostia. It comprises a small gauge support wire to provide real-time, tactile feedback as you progress through Schlemm’s canal: this allows you to feel if the canal is tight, grainy or completely open. It also makes it possible for you to maneuver through tight areas of the canal. Additionally, you can precisely control the delivery of viscoelastic, as required, to overcome blockages or any areas of resistance.

Meet the Experts

ABiC: An Evolution of Canaloplasty
Interview with Mahmoud A. Khaimi, MD (USA)

In this video interview, US glaucoma surgeon Dr. Khaimi addresses his experience with Canaloplasty. One of the early adopters of Canaloplasty, he has performed more than 1000 procedures. He is currently pioneering the clinical development of ABiC, an ab-interno MIGS procedure derived from Canaloplasty.

ABiC: Introducing A New MIGS
Interview with Mark J. Gallardo, MD (USA)

According to Mark J. Gallardo, ABiC has worked so well to control his patients’ IOP and to reduce their medication load that it has become his “go-to” procedure for patients requiring (glaucoma) surgical intervention.