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Editors Selection IGR 25-1

Surgical Treatment: Sectorial cyclodialysis with bio-scaffold scleral reinforcement to enhance uveoscleral outflow and reduce IOP

Comment by Patrick Wu & Robert Feldman on:

121940 Bio-Interventional Cyclodialysis and Allograft Scleral Reinforcement for Uveoscleral Outflow Enhancement in Open-Angle Glaucoma Patients: One-Year Clinical Outcomes, Ianchulev T; Weinreb RN; Calvo EA et al., Clinical Ophthalmology, 2024; 18: 3605-3614

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This article reports on a novel surgical intervention called bio-interventional cyclodialysis with allograft scleral reinforcement for treating open-angle glaucoma. The surgical technique aims to enhance the uveoscleral pathway, a less commonly targeted drainage route in glaucoma surgery. This procedure utilizes a bio-scaffold made of acellular donor scleral allograft tissue, which theoretically prevents closure of a surgical cyclodialysis cleft. After 12 months, results showed a significant reduction in intraocular pressure by 6.3 mmHg, and a decrease in the number of IOP-lowering medications required in a mixed standalone and cataract combined population. However, the information provided has significant limitations. The results are limited to a follow-up one year. While this does provide some preliminary insight into the procedure’s outcomes, it can only be considered a mid-term assessment. A one-year timeframe limits the ability to assess late complications, disease progression, or regression of benefits especially when the procedure has been combined with cataract surgery. A particular concern arises with the attribution of cystoid macular edema (CME). The authors do not provide a clear basis for distinguishing whether CME is attributable to the cataract surgery or the cleft procedure. Without specific differentiation strategies, such claims remain speculative and potentially misleading. Additionally, the study does not present sufficient data to support comparisons with other techniques. Drawing conclusions or implying comparability or superiority relative to other MIGS or surgical approaches is beyond the scope of this case series. Any such comparisons are speculative until comparative studies are performed. While the presented data can be considered a useful first step, it is not definitive. Further research, ideally in the form of randomized controlled studies with standardized techniques, is warranted given the reported efficacy and safety but there is not enough data to support widespread use at his time.

In conclusion while the data are interesting and suggest potential for this intervention the conclusions are limited to those in the abstract: “IOP lowering through uveoscleral outflow enhancement can be achieved by means of a bio-interventional cyclodialysis procedure with allograft scleral reinforcement.”

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