Post-Operative Outcomes at One Year of STREAMLINE Microinvasive Glaucoma Surgery Combining Micro-Goniotomy and Focal Ab-Interno Canaloplasty.

Purpose: The STREAMLINE Surgical System performs microinvasive glaucoma surgery (MIGS) by creating micro-goniotomy incisions in the trabecular meshwork with focal ab-interno canaloplasty of Schlemm's canal. This retrospective review examines the procedure's effect on intraocular pressure (IOP) and number of glaucoma medications throughout one post-operative year.

Methods: All cases at the John A. Moran Eye Center with Current Procedural Terminology codes 65820 and 66174 were searched for STREAMLINE cases from October 2021 to May 2024. Eyes were excluded if the case was combined with another procedure other than phacoemulsification, did not include both goniotomy and ab-interno canaloplasty, or was a standalone STREAMLINE procedure without phacoemulsification. Demographic data and baseline number of medications and IOP were recorded. IOP measurements were recorded on post-operative day 0, week 1, month 1, month 3, month 6, month 9, and month 12. Number of medications was recorded post-operatively at 6 months and 12 months. Linear mixed effects models were fit to estimate IOP at each follow-up time while accounting for within-eye correlation.

Results: Thirty-nine eyes that underwent the procedure were included from 29 patients of ages 18-86. The average IOP decrease from baseline IOP was 0.68 mmHg on post-operative day 0 (p=0.52), 1.49 mmHg at post-operative month 1 (p=0.16), 1.67 mmHg at post-operative month 3 (p=0.17), 1.62 mmHg at post-operative month 6 (p=0.18), 1.05 mmHg at post-operative month 9 (p=0.36), and 1.87 mmHg at post-operative month 12 (p=0.13). There was a post-operative IOP increase of 0.18 mmHg at post-operative week 1 (p=0.88). The average number of glaucoma medications was reduced by 47% at 6 months post-operatively (p<0.001) and 48% at 12 months (p=0.003).

Conclusion: In a retrospective review of 39 eyes at one institution, STREAMLINE goniotomy and ab-interno canaloplasty significantly decreased the number of glaucoma medications one year after surgery.