Long-Term Outcomes and Safety of Non-Cyclodialytic, Bleb-Independent Surgical Enhancement of Uveoscleral Outflow in Open-Angle Glaucoma, with Evaluation of the Role of Conjunctival Lymphatic Vessels in Suprachoroidal Drainage.

@article{kumar2026longterm,
  title = {{Long-Term Outcomes and Safety of Non-Cyclodialytic, Bleb-Independent Surgical Enhancement of Uveoscleral Outflow in Open-Angle Glaucoma, with Evaluation of the Role of Conjunctival Lymphatic Vessels in Suprachoroidal Drainage.}},
  author = {Vinod Kumar and Mikhail Aleksandrovich Frolov and Galina Nikolaevna Dushina and Andrey Igorevich Bezzabotnov and Ahmad Saleh Soliman Shradqa and Zarina Shaykuliyevna Rustamova},
  journal = {Vision (Basel, Switzerland)},
  year = {2026},
  month = oct,
  doi = {10.3390/vision10040084},
  url = {https://europepmc.org/article/MED/42931622},
  note = {CC BY},
}

TY  - JOUR
TI  - Long-Term Outcomes and Safety of Non-Cyclodialytic, Bleb-Independent Surgical Enhancement of Uveoscleral Outflow in Open-Angle Glaucoma, with Evaluation of the Role of Conjunctival Lymphatic Vessels in Suprachoroidal Drainage.
AU  - Vinod Kumar
AU  - Mikhail Aleksandrovich Frolov
AU  - Galina Nikolaevna Dushina
AU  - Andrey Igorevich Bezzabotnov
AU  - Ahmad Saleh Soliman Shradqa
AU  - Zarina Shaykuliyevna Rustamova
PY  - 2026
DA  - 2026/10/15
JO  - Vision (Basel, Switzerland)
DO  - 10.3390/vision10040084
UR  - https://europepmc.org/article/MED/42931622
AB  - Purpose: To evaluate long-term outcomes and safety of non-cyclodialytic, bleb-independent surgical enhancement of uveoscleral outflow for intraocular pressure (IOP) reduction in open-angle glaucoma (OAG), and to assess the role of conjunctival lymphatic vessels (CLVs) in suprachoroidal drainage. Methods: In this single-center consecutive case series, 70 eyes of 63 patients (mean age 75.0 years; 70% female) with moderate-to-severe OAG underwent uveoscleral outflow enhancement. Twenty-two eyes had standalone surgery; 48 eyes had combined phacoemulsification with glaucoma surgery. Mean follow-up was 24.1 months (range 5.3-60.4). Primary outcomes were IOP reduction and surgical success by Kaplan-Meier analysis (sustained failure: IOP > 18 mmHg or < 20% reduction from baseline at two consecutive available postoperative visits, excluding day 1). CLVs were assessed by slit-lamp and OCT at 11 time points over 36 months. Mixed-effects models with random intercept per eye were used for repeated measurements. Logistic regression with cluster-robust standard errors evaluated predictors of CLV visibility. Results: Baseline IOP of 28.8 ± 8.4 mmHg decreased to 12.3 ± 4.5 mmHg at 1 month (54.5% reduction) and 14.5 ± 2.5 mmHg at 36 months (46.2% reduction, n = 22). Medications decreased from 2.77 ± 0.94 to 1.36 ± 1.09 at 36 months. Overall surgical survival was 91.4% at 1 month, 82.0% at 12 months, and 74.1% at 36 months. Fifteen eyes (21.4%) met sustained failure criteria (standalone surgery group: eight, combined surgery group: seven; and log-rank p = 0.038). The combined surgery group showed higher survival at 36 months (82.6% vs. 58.5%), but the difference did not reach significance. CLVs were detected in 51.4% by slit-lamp and 96.4% by OCT, peaking at 1 month. Before surgery, CLVs were not detected on OCT in any eye. Time was a significant negative predictor of CLV visibility on both slit-lamp (OR 0.953/month, p = 0.046) and OCT (OR 0.935/month, p = 0.003), without independent association with IOP or medication burden, suggesting that CLVs facilitate suprachoroidal drainage as a structural mechanism rather than a reactive response to IOP changes. Conclusions: Non-cyclodialytic, bleb-independent uveoscleral outflow enhancement provides sustained IOP reduction with favorable safety. CLVs, nearly universally detected by OCT after surgery, appear to contribute to suprachoroidal drainage. Combined surgery showed a trend toward greater surgical success than standalone procedures.
SN  - 2411-5150
ER  -