Bio-Interventional Cyclodialysis and Allograft Scleral Reinforcement for Uveoscleral Outflow Enhancement in Open-Angle Glaucoma Patients: One-Year Clinical Outcomes

Tsontcho Ianchulev,1,&ast; Robert N Weinreb,2,&ast; Ernesto A Calvo,3,&ast; James Lewis,4,&ast; Gautam Kamthan,1,&ast; Arsham Sheybani,5,&ast; Douglas J Rhee,6,&ast; Iqbal K Ahmed7,&ast; 1Department of Ophthalmology, New York Eye and Ear of Mount Sinai, New York, NY, USA; 2Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA; 3Clínica de Ojos Orillac-Calvo, Panama City, Panama; 4Cataract Philadelphia, Elkins Park, PA, USA; 5Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA; 6Department of Ophthalmology & Visual Sciences, University Hospitals, Case Western Reserve University, Cleveland, OH, USA; 7John Moran Eye Center, University of Utah, Salt Lake City, UT, USA&ast;These authors contributed equally to this workCorrespondence: Tsontcho Ianchulev, Ophthalmology, New York Eye and Ear of Mount Sinai, New York, NY, USA, Email [email protected]: To evaluate the one-year safety and effectiveness of bio-interventional cyclodialysis and scleral reinforcement in open-angle glaucoma (OAG) patients undergoing cataract surgery.Methods: An ab-interno approach was used to create a sectoral cyclodialysis in OAG patients who were prospectively followed in a consecutive case series. Subsequent visco-cycloplasty with scleral reinforcement using homologous minimally modified allograft scaffold was completed to maintain patency of the cyclodialysis reservoir and increase uveoscleral outflow. Outcomes were mean medicated IOP and mean number of IOP-lowering medications. Safety outcomes were adverse events (AEs) and best-corrected visual acuity (BCVA) changes.Results: Successful cyclodialysis and allograft bio-scaffold reinforcement was achieved in 117 eyes. There was minimal intraoperatie bleeding and few post-operative adverse events. At baseline, mean BCVA was 0.48 (95% CI: 0.42‒0.54; 20/40 Snellen) and mean ± SD medicated IOP was 20.2 ± 6.0 mmHg on 1.4 ± 1.3 IOP-lowering medications. At 12 months, there was a 27.1% reduction from baseline mean medicated IOP. In eyes with medicated baseline IOP > 21 mmHg (n = 45), there was a 39.7% paired IOP reduction at 12 months with a concurrent reduction in the mean number of IOP lowering medications to 0.8 ± 0.9 which were statistically significant (p < 0.01). For all eyes, 81.9% achieved a medicated IOP ≤ 18 mmHg with no increase in medications at 12 months. To achieve target IOP control, secondary glaucoma surgery was performed in 3.2% of the cases.Conclusion: IOP lowering through uveoscleral outflow enhancement can be achieved by means of a bio-interventional cyclodialysis procedure with allograft scleral reinforcement.Keywords: glaucoma, open-angle, intraocular pressure, cataract, allografts