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iTrack™ Canal-Based Glaucoma Surgery

iTrack™ Canal-Based Glaucoma Surgery

A restorative approach to glaucoma.

iTrack™ canal-based glaucoma surgery is a comprehensive, minimally invasive treatment option that can effectively reduce IOP and eliminate or reduce the medication burden. Restorative and atraumatic, it can be performed as a standalone procedure – and in conjunction with cataract surgery and MIGS options.

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Main Image Landing Abic Itrack

No tissue damage, no stents or shunts 

iTrack™ canal-based glaucoma surgery comprehensively addresses blockages in the collector channels and flushes the outflow pathway without damaging tissue and without leaving behind a stent or shunt. Specifically, iTrack™ canal-based glaucoma surgery re-establishes the eye’s natural outflow system by accessing, catheterizing and viscodilating the trabecular meshwork, Schlemm’s canal, and the distal outflow system. 360º viscodilation of Schlemm’s canal can separate the compressed tissue planes of the trabecular meshwork, causing any herniated inner wall tissue to withdraw from the collector channels. This complements the mechanic opening achieved via the circumnavigation of the iTrack™ microcatheter through Schlemm’s canal.

  • Restores the natural outflow pathway —safely and efficaciously
  • Addresses all outflow pathway resistance points — atraumatically
  • Comprehensively addresses blockages in the collector channel ostia
  • Can be performed in conjunction with cataract surgery, and as a standalone procedure
  • Can be performed across the entire glaucoma disease process — before, and after, other MIGS

Watch how iTrack™ canal-based glaucoma surgery comprehensively addresses all aspects of the natural outflow pathway.

WATCH THE iTrack™ ANIMATION HERE

Removing the guesswork from MIGS 

The most defining aspect of iTrack™ canal-based glaucoma surgery is its comprehensive approach. To date, iTrack™ is the only minimally invasive glaucoma surgery that successfully and comprehensively addresses all aspects of potential outflow resistance. This contrasts with other MIGS procedures, where only a segment of Schlemm’s canal is addressed, or where the trabecular meshwork is targeted in isolation. When using a stent-based MIGS there is a risk that the area of blockage will be missed or sub optimally treated.

Standalone or complementary

Intuitive and efficient, iTrack™ canal-based glaucoma surgery can be performed as a standalone procedure, or in conjunction with cataract surgery.

Further, iTrack™ canal-based glaucoma surgery can be deployed synergistically with Selective Laser Trabeculoplasty (SLT) to control IOP by restoring the natural outflow pathways. SLT stimulates cellular regeneration to create a healthier, more porous trabecular meshwork structure, and achieves an average 30% reduction in IOP when used as a first-line therapy. Additionally, ABiC™ can be used in conjunction with other MIGS devices or treatments — and, as an atraumatic procedure, it does not preclude future treatment options.

iTrack™, Ab-Interno

Ab-interno canaloplasty or ABiC™, performed with the iTrack™ surgical system, re-establishes the eye’s natural outflow system by accessing, catheterizing and viscodilating the trabecular meshwork, Schlemm’s canal, and the distal outflow system. 360º viscodilation of Schlemm’s canal can separate the compressed tissue planes of the trabecular meshwork, causing any herniated inner wall tissue to withdraw from the collector channels. This complements the mechanic opening achieved via the circumnavigation of the iTrack™ microcatheter through Schlemm’s canal. On average, it achieves a reduction in IOP of 30% and a 50% reduction in medication dependence. It’s a minimally invasive glaucoma surgery that allows you to lower IOP and/or reduce the patient medication burden, both in cases of controlled and uncontrolled glaucoma — maximizing efficacy and minimizing tissue trauma.

A consecutive case series by Dr. Mark J. Gallardo and colleagues demonstrated the clinical safety and efficacy of iTrack™ (ab-interno) canal-based glaucoma surgery over a 12-month period. The study compared the efficacy of iTrack™ when performed as a stand-alone procedure, or as an adjunct to cataract surgery.1

  • Stand-alone iTrack™ (n=41) achieved mean IOP reduction of 32.8%, and medication use reduction of 51.1% (P<0.001) at 12 months.
  • iTrack™ performed in conjunction with cataract surgery (n=34) achieved mean IOP reduction of 31.7%, and mean medication decrease of 71.1% at 12-months (both P<0.001).
  • At 12 months, 30.8% of eyes treated with stand-alone iTrack™ were medication-free
  • At 12 months, 50% of eyes treated with combined iTrack™ and cataract surgery were medication-free.
  • On average, 84.9% of eyes experienced a reduction in IOP of more than 20%.

Overall, there was a significant reduction in mean IOP (32.3%) and medications (60.0%) from baseline at 12 months.

1. Gallardo MJ, Supnet RA, Ahmed IIK. Viscodilation of Schlemm’s canal for the reduction of IOP via an ab-interno approach. Clinical Ophthalmology. Vol 12. August 2018. https://doi.org/10.2147/OPTH.S177597

iTrack™, Ab-Externo

For patients with later stage disease, ab-externo canaloplasty performed with the iTrack™ surgical system is a proven and effective solution that means patients avoid the risks and discomfort associated with trabeculectomy.

With over 70,000 procedures performed to date, clinical studies show that ab-externo canaloplasty has an excellent safety profile, with minimal post-operative follow-up, faster recovery times, and infrequent intra-operative and post-operative complications.2 Ab-externo canaloplasty doesn’t produce a filtering bleb, and hence patients can resume day-to-day activities directly following treatment with minimal follow-up required.

During the procedure, 360º viscodilation of Schlemm’s canal opens up the ostia of the collector channels and re-establishes outflow. Additionally, the creation of the scleral lake, Descemet’s window and a tensioning suture help to contribute to a sustained reduction in IOP. On average, ab-externo canaloplasty delivers post-operative pressures in the range of 12-14 mm Hg, similar to that achieved with trabeculectomy1

In a three-year multi-center trial by Lewis et al, ab-externo canaloplasty achieved significantly lower IOP and dependence on medications. Where patients underwent ab-externo canaloplasty separate to cataract surgery, mean IOP was reduced by 35% from 23.5 mm Hg to 15.5 mm Hg at 36 months. When performed in conjunction with cataract surgery, the technique resulted in a 42% reduction in mean IOP from 23.5 mm Hg to 13.6 mm Hg, combined with an 80% reduction in medications.3

2. Brüggemann A, Despouy JT, Wegent A, Müller M. Intraindividual comparison of Canaloplasty versus trabeculectomy with mitomycin C in a single-surgeon series. J Glaucoma. 2013;22(7):577-583.

3. Lewis RA, von Wolff K, Tetz M, et al. Canaloplasty: three-year results of circumferential viscodilation and tensioning of Schlemm’s canal using a microcatheter to treat open-angle glaucoma. J Cataract Refract. Surg. 2011(37):682-690.

“I have been a practicing glaucoma specialist for over 10 years. The introduction of iTrack™ has completely changed my glaucoma treatment paradigm. Not only has iTrack™ proven itself to be highly effective in lowering IOP and reducing medication dependence, it also offers an excellent safety profile. There is no manipulation of the conjunctiva, and the post-op recovery resembles that of cataract surgery.”
Khaimi
“Rather than trying to mechanically change or bypass the pathway of aqueous outflow, iTrack™ canal-based glaucoma surgery acts to restore the natural outflow process by targeting all aspects of the outflow system; that is, the trabecular meshwork, Schlemm’s canal, and the collector channels. This is an important distinction of this procedure — especially considering that it is not always understood where the point of maximum resistance lies. It therefore makes sense to apply a procedure that comprehensively addresses the entire outflow system.”
Gallardo
“While various MIGS devices may work on specific sections of the outflow system, the multiple mechanisms of iTrack™ let us hedge our bets and, in my opinion, have a better chance of getting that reduction of pressure in the right type of patient population.”
Singh

Resources

Video

iTrack™ Canal-Based Glaucoma Surgery: Restoring Natural Outflow - Mahmoud A. Khaimi, MD (USA)

Article

Meet the Masters of the New Comprehensive MIGS

This article discusses the role of ABiC, which has grown into a procedure that is effective, safe and easily combined with other MIGS interventions. Contributing authors include Mahmoud Khaimi, MD (USA), Norbert Koerber, MD, PhD (Germany), Mark Gallardo, MD (USA), Sev Teymoorian, MD (USA) and Leon Au, MD (UK).

Case Study

MIGS: Restoration of Normal Outflow Aqueous Pathways

The March 2018 issue of CRST featured a case study by Dr. David Lubeck in which ABiC was successfully performed in a patient post-SLT and iStent – speaking to the versatility of iTrack in clinical practice.

Case Study

MIGS: A New Paradigm to Treat Glaucoma

Featuring Dr. Mahmoud Khaimi, this CRST article features a case study on the synergies of ABiC and SLT – and the benefits of performing these two procedures in combination.

Article

Roundtable Discussion, MIGS with ABiC

Featuring Ike K. Ahmed, MD, this panel discussion on microinvasive glaucoma surgery (MIGS) addresses the collective wisdom and experiences of a leading panel of MIGS experts.

Article

ABiC In the Media, Glaucoma Today

In this article ABiC pioneer Mahmoud A. Khaimi, MD addresses his experience with ABiC, contrasting it against the other MIGS procedures available.

Associated websites

iTrack Patient Education

A simple three-step procedure, learn how ABiC™ can reduce the elevated intraocular pressure associated with glaucoma.

Video

ABiC: A Comprehensive Solution

In this video interview, glaucoma expert Mahmoud A. Khaimi, MD (USA), describes the advent of ABiC™ performed with the iTrack™ surgical system.

Video

ASCRS Glaucoma Roundtable: ABiC in the Spotlight

Iqbal Ike K. Ahmed, MD, FRCSC, asks a group of experts to address the misconceptions and barriers to adoption for ab interno canaloplasty (ABiC).

Video

ABiC: iTrack Animation

Watch the iTrack™ as it circumnavigates Schlemm’s, separating the herniations of the meshwork into the collector channels and breaking inner lumen adhesions.

Video

ABiC: Restoring the Outflow Pathway

In this video Mahmoud A. Khaimi, MD (USA) demonstrates restoration of the natural outflow pathway with ABiC™.

Video

ABiC According to the Expert

According to iTrack™ expert Mark J. Gallardo, MD (USA), proper visualization of the nasal drainage angle is crucial to the success of ABiC™.

Contact us


Ellex is the manufacturer of the iTrack™ Canaloplasty microcatheter for the reduction of intraocular pressure (IOP) in adult patients with open-angle glaucoma. It has been approved for the indication of fluid infusion and aspiration during surgery, and for catheterization and viscodilation of Schlemm’s canal during the ABiC (ab-interno Canaloplasty) procedure. Ellex does not accept any responsibility for use of the iTrack Canaloplasty microcatheter outside of these indications.

iTrack™ has a CE Mark (Conformité Européenne) and US Food and Drug Administration (FDA) 510(k) # K080067 for the treatment of open-angle glaucoma.

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