Glaucoma is a leading cause of irreversible blindness in the world.1 The only proven treatment is to lower intraocular pressure (IOP) either by increasing aqueous humor outflow (AHO) or decreasing aqueous humor production. IOP lowering has traditionally been achieved by topical medications, laser therapy, or filtering surgery. New and innovative surgical procedures classified as minimally invasive (or microincisional) glaucoma surgery (MIGS) now offer an additional opportunity to lower IOP by enhancing AHO.2 Canal-based MIGS such as the Trabectome (Neomedix, Tustin, CA), iStent (Glaukos Corporation, Laguna Hills, CA), Hydrus microstent (Ivantus, Irvine, CA), gonioscopy-assisted transluminal trabeculotomy, Trab 360 (Sight Sciences, Menlo Park, CA), and excimer laser trabeculotomy work on the premise of bypassing or ablating the juxtacanalicular trabecular meshwork (TM), which is considered to be the portion of the conventional AHO pathway responsible for a significant amount of outflow resistance.
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