Canaloplasty and Trabeculotomy with the OMNI System in Patients with Open-Angle Glaucoma: Two-Year Results from the ROMEO Study

PURPOSE: To provide extended safety and effectiveness follow-up for eyes treated with circumferential canaloplasty and trabeculotomy (CP+TR) that were included in the 12-month ROMEO study. SETTING: Seven multi-subspecialty ophthalmology practices located in 6 states (Arkansas, California, Kansas, Louisiana, Missouri, and New York). DESIGN: Retrospective, multicenter, IRB approved. SUBJECTS: Eligible eyes had mild–moderate glaucoma and were treated with CP+TR with cataract surgery or as a standalone intervention. METHODS: Main outcome measures were mean IOP, mean number of ocular hypotensive medications, mean change in number of medications, proportion of patients with a ≥20% reduction in IOP or with IOP ≤18 mmHg, and proportion of patients medication free. Safety outcomes were adverse events and secondary surgical interventions (SSI). RESULTS: Eight surgeons at 7 centers contributed 72 patients stratified by pre-operative intraocular pressure (IOP); >18 mmHg (Grp1), ≤18 mmHg (Grp2). Mean follow-up of 2.1 years (min 1.4, max 3.5). 2-year IOP (SD) was 15.6 mmHg (−6.1 mmHg, −28% from baseline) on 1.4 medications (−0.9, −39%) for Grp1 with cataract surgery; 14.7 mmHg (−7.4 mmHg, −33% from baseline) on 1.6 medications (−0.7, −15%) for Grp1 standalone, 13.7 mmHg (−0.6 mmHg, −4.2%) on 1.2 medications (−0.8, −35%) for Grp2 with cataract surgery, 13.3 mmHg (−2.3 mmHg, −14.7%) on 1.2 medications (−1.0, −46%) for Grp2 standalone. The proportion of patients at 2 years with either a ≥20% IOP reduction or IOP between 6 and 18 mmHg and no increase in medication or SSI was 75% (54 of 72, 95% CI 69.9%, 80.1%). One-third of patients (24 of 72) were medication free whereas 9 of 72 were pre-surgical. No device-related adverse events during extended follow-up; 6 eyes (8.3%) required additional surgical or laser intervention for IOP control after 12 months. CONCLUSION: CP+TR provides effective IOP control that is sustained for 2 years or more.