AGS 2025: Aqueous humor outflow improvement after excimer laser trabeculostomy with Clemens Strohmaier, PhD

Clemens A. Strohmaier, PhD, presented findings on aqueous humor outflow improvement following the Elios procedure at the 2025 American Glaucoma Society (AGS) Annual Meeting, held February 26 to March 2 in Washington, DC. His research utilized aqueous humor angiography, a technique developed by Alex A. Huang, MD, PhD, with the Shiley Eye Institute in San Diego, California. Strohmaier’s poster was selected as a Top Poster Presentation of the meeting by AGS.

This method involves infusing specialized dyes into the anterior chamber to visualize outflow patterns before and after the procedure, allowing real-time assessment in live patients. The study demonstrated consistent outflow improvement across all investigated cases, reinforcing Elios' potential in enhancing MIGS efficacy.

A key objective is understanding why MIGS procedures, despite their safety, show variable efficacy in individual patients. The research, supported by Elios, aims to refine trabecular bypass surgery by identifying optimal placement strategies. The study found that aqueous humor outflow improvement did not always occur at the exact site of laser energy application, challenging assumptions about direct trabecular bypass-outflow correlation. Instead, outflow enhancement was observed adjacent to the treatment site, an unexpected finding prompting further investigation.

Building on these insights, an ongoing clinical study applies lab-based findings from Huang’s team to determine whether placing trabecular bypass in low-flow regions of the trabecular meshwork yields better clinical outcomes. Preliminary lab results suggest greater efficacy when targeting these areas, and the clinical trial is expected to validate this approach.

Strohmaier emphasizes that while the Elios procedure is simple, safe, and effective in improving outflow, broader challenges remain in translating MIGS success from lab settings to clinical practice. He suggested that episcleral circulation may play a limiting role in MIGS efficacy, an area that requires further exploration using advanced angiographic techniques. These findings pave the way for more precise, patient-specific surgical strategies to optimize glaucoma treatment outcomes.