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Trabeculectomy showed stronger long-term pressure control, while canaloplasty offered a safer profile with fewer complications.  

An 11-year cohort study published in June 2025 in the issue of BMC Ophthalmology evaluated the long-term outcomes of trabeculectomy versus canaloplasty (TVC) in individuals with open-angle glaucoma.  

They followed individuals from the original 2015 TVC cohort. Primary endpoints were complete success without glaucoma medication and qualified success with or without medication, defined as intraocular pressure (IOP) ≤ 18 mmHg [Definition 1] or IOP ≤ 21 mmHg with a ≥ 20% reduction from baseline [Definition 2]. Secondary endpoints included changes in IOP, medication usage, complications, and revision procedures.  

The results showed that the mean follow-up duration was 11.9 ± 1.1 years for trabeculectomy (TE) and 11.0 ± 2.0 years for canaloplasty (CP), involving 15 individuals of TE and 13 of CP. Complete success for TE vs CP was 53.3% vs 15.4% [Definition 1, P= 0.06] and 46.7% vs 15.4% [Definition 2, P= 0.22]. Qualified success rates were 73.3% for TE and 69.2% for CP [Definition 1, P= 1.0], and 66.7% vs 76.9% [Definition 2, P= 0.69]. Median IOP was 10.0 mmHg (range 6.0–12.0) for TE and 14.0 mmHg (range 11.5–17.75) for CP (P< 0.01). The mean number of glaucoma medications used was 1.0 ± 1.4 in the TE group and 1.9 ± 1.5 in the CP group (p = 0.17). Revision procedures were performed in 26.7% for TE and 23.1% for CP. Hypotony maculopathy was the only long-term complication noted in 15.4% of TE cases.  

Investigators concluded that TE provided superior long-term IOP reduction and complete success rates, while CP remained a safer option with fewer complications despite slightly higher pressures. 

Source: bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-025-04183-9