New World Medical has entered a crowded but evolving segment of glaucoma surgery with the Via360 surgical system, a device that combines canaloplasty and trabeculotomy in a single platform and is designed to give surgeons more direct control over viscoelastic delivery during angle-based procedures.

The system received 510(k) clearance from the US Food and Drug Administration (FDA) in February 2025 for the delivery of controlled amounts of viscoelastic fluid during ophthalmic surgery and for incising trabecular meshwork tissue during trabeculotomy. The device incorporates a microcatheter capable of advancing up to 360° within Schlemm’s canal, along with proprietary ActiveInject technology that allows surgeons to deliver viscoelastic on demand, independent of catheter movement. Microchannels along the length of the catheter allow viscoelastic to be delivered both forward and laterally for targeted outflow modulation.

Surgeon-Controlled Viscodilation

For glaucoma specialists, the Via360 system distinguishes itself from earlier canal-based MIGS devices by pairing combined canaloplasty and trabeculotomy with surgeon-controlled, on-demand viscoelastic delivery, rather than flow constrained by catheter movement or device settings.

Philip S. Garza, MD, MSc, a glaucoma specialist and cataract surgeon at Thomas Eye Group in Atlanta, said his adoption of the device has been shaped by the surgeon-controlled dual capability and its unique delivery of viscoelastic through its catheter’s microchannels. “We consider MIGS for every patient who may benefit from reduction in IOP, topical glaucoma medication burden, or both,” he said. “In particular, given its dual mechanism of action, we deploy the Via360 when a patient would benefit from maximum IOP lowering by combining both canaloplasty and trabeculotomy in a single surgery.”

The ability to titrate treatment intraoperatively is central to that approach. “Via360 gives us the confidence to recommend MIGS more widely than ever before, because we can customize the amount of canaloplasty and/or trabeculotomy we perform to each patient’s specific circumstances and risk profile,” said Dr. Garza.

Unlike systems that rely on assistant-driven injection or passive flow, ActiveInject enables direct surgeon modulation. “The Via360 elevates the efficiency of the procedure by allowing me to deliver viscoelastic exactly where and when it’s needed, with complete control at my fingertips,” said Inder Paul Singh, MD, president of the Eye Centers of Racine and Kenosha in Wisconsin, at the time the device received FDA clearance.

Dr. Garza agrees. “Via360’s ActiveInject technology is unique in that it gives the surgeon direct, handheld control over viscoelastic delivery,” he said. “This removes the need to direct a technician and allows for precise, titratable control of viscodilation.”

That level of control may be particularly relevant in procedures aimed at addressing distal outflow resistance. “It allows us to open downstream collector channels through surgeon-controlled viscodilation,” explained Dr. Garza, noting that the system also permits a titratable trabeculotomy when additional outflow enhancement is needed.

Navigating Schlemm’s Canal

The device’s microcatheter design is intended to support circumferential treatment of Schlemm’s canal. “In the vast majority of cases, I can advance the microcatheter 360°,” he said. “If I encounter resistance, a slight withdrawal and injection of viscoelastic via ActiveInject typically allows me to pass the obstruction. While there’s always a possibility of the catheter entering collector channels or other unintended areas, the design allows for tactile feedback that helps me ensure I remain in Schlemm’s canal, so that’s rarely a concern.”

The system also includes a rotatable cannula designed to maintain access through a single corneal incision, even when full circumferential access is not initially possible. “In cases where I can’t advance fully 360°, the rotatable cannula allows me to complete the treatment from the opposite direction,” Dr. Garza said. “I withdraw the device, rotate the tip outside the eye, and reenter the anterior chamber and Schlemm’s canal through the same corneal incision and goniotomy.”

These design features aim to preserve surgical efficiency while maintaining flexibility, particularly in anatomically complex cases.

Beyond intraoperative control, the system is designed to reduce complexity and prep time, reflecting ongoing efforts to integrate MIGS procedures into high-volume surgical settings without adding complexity or time. The system incorporates a Smart Prime feature that prepares and optimizes viscoelastic volume within the handpiece, reducing waste and streamlining setup. “Via360 is an all-in-one device, making priming with viscoelastic very efficient,” Dr. Garza said. “This requires minimal training for surgical technicians, and its self-contained design minimizes prep time and eliminates tubing management.”

Patient Selection and Early Clinical Experience

Clinically, Dr. Garza said the system has shown promise in patients with elevated outflow resistance at multiple levels. “As a combination canaloplasty-trabeculotomy device, Via360 addresses resistance to outflow both within the trabecular meshwork and downstream in Schlemm’s canal and the collector channels,” he said. “It is broadly applicable to patients with open-angle glaucoma.”

He highlighted specific subgroups where early experience has been notable. “In cases of pigment dispersion syndrome, pseudoexfoliation syndrome, and steroid response glaucoma, I’ve been particularly impressed with large reductions in both IOP and topical medication burden,” he said. “These are patients whose only other option until recently would have been filtering surgery due to very high IOP and medication dependency.”

In some instances, those outcomes may alter the surgical pathway. “I have a handful of cases that are remarkable in that the technique allowed patients who would otherwise have required filtering surgery due to significant IOP elevation to avoid anatomy-altering surgery,” Dr. Garza said. “In these cases, we achieved normalization of IOP with minimal need for topical glaucoma eye drops.”

This reflect a broader goal within MIGS: delaying or avoiding more invasive filtration procedures when possible. “Even just a few years ago, these patients would have required filtering surgery,” Dr. Garza said. “The technique can deliver surprisingly powerful results while preserving filtering surgery as a future option.”

Another aspect of the system is its compatibility with adjunctive therapies. “Via360 allows for multiple IOP-lowering procedures with different mechanisms to be performed in the same surgery,” Dr. Garza said. He noted that the device can be combined with sustained drug delivery implants without additional procedural burden. “When combined with sustained drug delivery, it’s a three-in-one procedure.”

The ability to tailor treatment extent, ranging from limited canaloplasty to more extensive trabeculotomy, aligns with a shift toward individualized surgical planning.

Looking Ahead

As with other MIGS technologies, long-term outcomes and comparative data will be important in defining the device’s role. For now, early users describe a system that integrates multiple treatment mechanisms into a single platform while emphasizing surgeon control. “A major procedural advantage with the Via360 system is that you can perform as much or as little canaloplasty and trabeculotomy as you see fit for the particular patient,” Dr. Garza said. “This allows us to maximize both treatments for the patients who we know need it most.” GP