Real-World Outcomes of Combined Goniotomy and Canaloplasty Using the Streamline Surgical System.

PURPOSE: To evaluate real-world outcomes of combined goniotomy and canaloplasty, performed with the Streamline Surgical System, on intraocular pressure (IOP) and medication burden in patients with ocular hypertension and open-angle glaucoma in a US-based clinical practice. PATIENTS AND METHODS: This retrospective, single-center chart review included patients who underwent the Streamline procedure either as standalone or in combination with cataract surgery between January 2022 and December 2023. Outcome measures included change in mean IOP and number of IOP-lowering medications from baseline through 12 months, analyzed in the overall cohort, with exploratory subgroup analyses stratified by race and glaucoma severity (mild, moderate, severe). RESULTS: A total of 132 eyes (132 patients, 54.5% African-American) were included. The Streamline procedure was performed in combination with cataract surgery in 119 eyes and as a standalone procedure in 13 eyes. Mean IOP decreased significantly from 17.1±5.8 mmHg at baseline to 13.2±4.1 mmHg at 12 months (p<0.001), and the mean number of IOP-lowering medications decreased from 1.6±1.3 to 1.2±1.5 (p<0.001). When stratified by race, no consistent differences in mean IOP or medication use were observed between African-American and Caucasian patients across postoperative visits, except at the 3-month time point. Reductions in mean IOP were observed across all glaucoma severity subgroups; however, statistical significance was achieved only in the mild and moderate subgroups. Reductions in medication burden were observed in the mild and moderate subgroups, with statistical significance only in the mild subgroup. Interpretation of these findings is limited by the retrospective design and the predominance of combined cataract procedures, which precludes isolation of the independent effect of the Streamline procedure. CONCLUSION: Streamline goniotomy with canaloplasty was associated with significant reductions in mean IOP and medication burden through 12 months in a real-world clinical cohort.