Illuminate the concealed: An innovative method to identify the path of Schlemm’s canal

Background: Trabeculotomy is a widely used surgical procedure for reducing intraocular pressure in primary congenital glaucoma. [1] Accurate identification of Schlemm’s canal is the most critical step for surgical success. [2] Conventional landmarks such as the blue-white limbal junction and perforating vessels often become indistinct in buphthalmic eyes due to limbal stretching, making localization difficult and increasing the risk of inadvertent entry into the anterior chamber. [3,4] Purpose: To present a novel, low-cost technique for identifying the path of Schlemm’s canal during trabeculotomy using a 25-gauge light pipe, particularly in eyes with stretched limbal anatomy. Synopsis: In this technique, a 25-gauge light pipe is introduced under the scleral flap prior to insertion of the Harms trabeculotome. The transmitted light helps illuminate and delineate the trajectory of Schlemm’s canal. This aids in guiding the trabeculotome and reduces the likelihood of false passages into the anterior chamber. This innovative method is simple, feasible, and more affordable compared to illuminated microcatheter systems such as iTrack, which are costly and often unavailable in resource-limited settings. [5-7] The light pipe provides enhanced visualization of the canal path, facilitating safer and more precise trabeculotomy. However, limitations include the inability to visualize the cut ends of Schlemm’s canal and the relatively larger diameter of the light pipe compared to the canal, restricting its use in smaller canals, with the possibility of false passages. Highlights: The light pipe-guided technique offers a practical and effective alternative for canal tract identification in challenging trabeculotomy cases, with potential to improve surgical outcomes in congenital glaucoma. Video link: https://youtu.be/8vvpmuaWkNw