AGS 2025: Two-year data of bio-interventional cyclodialysis with scleral allograft with Leon W. Herndon Jr, MD

Leon W. Herndon Jr, MD, presented 2-year data on a novel bio-interventional cyclodialysis surgery that leverages the suprachoroidal space with scleral allograft reinforcement at the 2025 American Glaucoma Society Annual Meeting, held February 26 to March 2, in Washington, DC. This approach revisits a previously utilized drainage pathway, which allows for up to 30% to 40% aqueous outflow, offering an alternative to trabecular meshwork-based minimally invasive glaucoma surgery (MIGS) procedures.

The study followed nearly 90 eyes undergoing combined cataract surgery and cyclodialysis, demonstrating a 25% reduction in IOP at 24 months, along with a significant decrease in medication burden. Importantly, the procedure maintained a favorable safety profile, with a hyphema rate of only 1%, underscoring its tolerability. Given historical concerns about cyclodialysis clefts leading to complications such as pain and hyphema, these findings support the safety and viability of re-engaging with the suprachoroidal space.

Herndon highlighted the potential for standalone indications beyond combined cataract surgery, with prospective comparative trials as the logical next step. With an increasingly crowded MIGS landscape, it is crucial to evaluate how suprachoroidal techniques compare with established trabecular meshwork-based procedures such as iStent, Hydrus, and Kahook dual blade. This technology aligns with the safety profiles of these existing MIGS options, reinforcing its potential role in glaucoma management.

Additionally, the use of scleral allograft tissue provides an added advantage. Already a mainstay in glaucoma tube surgeries, this tissue has demonstrated long-term biocompatibility and is not perceived as a foreign body by the eye, he noted. Its integration into this novel approach enhances the procedure’s safety and familiarity for glaucoma surgeons.

Herndon expressed his optimism about the clinical adoption of this technique and anticipates further research to solidify its place in the evolving MIGS landscape through randomized controlled trials.