Cyclodialysis Surgery for Glaucoma Management: A Systematic Review and Meta-Analysis of 100 Years of Clinical Evidence

Robert Stamper; Alex Huang; Carol Toris; Mary Qiu; Gerry Gray; Reena Garg; Tsontcho Ianchulev

doi:10.2147/OPTH.S538438

Cyclodialysis Surgery for Glaucoma Management: A Systematic Review and Meta-Analysis of 100 Years of Clinical Evidence

Clin Ophthalmol. 2025 Aug 21:19:2859-2870. doi: 10.2147/OPTH.S538438. eCollection 2025.

Authors

Robert Stamper¹, Alex Huang², Carol Toris³, Mary Qiu⁴, Gerry Gray⁵, Reena Garg⁶, Tsontcho Ianchulev⁷

Affiliations

¹ UCSF Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA.
² Shiley Eye Institute, UCSD, San Diego, CA, USA.
³ Department of Ophthalmology, The Ohio State University, Columbus, OH, USA.
⁴ Cleveland Clinic Department of Ophthalmology, Cleveland, OH, USA.
⁵ Data-Fi, LLC Biostatistics, Los Angeles, CA, USA.
⁶ Department of Ophthalmology, Georgetown University, Washington, DC, USA.
⁷ New York Eye and Ear of Mount Sinai, Icahn School of Medicine, New York City, NY, USA.

Abstract

Synopsis: A meta-analysis of over 4000 glaucoma cases over 100 years of surgical experience demonstrates that cyclodialysis surgery is effective in lowering intraocular pressure (IOP) as an uveoscleral outflow enhancing procedure.

Objective: To conduct a systematic review and meta-analysis evaluating the clinical efficacy and safety of surgical cyclodialysis in lowering intraocular pressure in glaucoma patients.

Methods: A comprehensive search of PubMed, Cochrane, Web of Science, and EMBASE identified peer-reviewed interventional studies involving surgical cyclodialysis for IOP reduction. Key outcome measures included long-term IOP control, medication burden, and adverse event incidence. The meta-analysis was registered with PROSPERO (ID: CRD42025632759).

Results: Forty studies spanning more than a century and including 4082 eyes were analyzed. Most studies were observational and non-randomized, with 75% employing ab-externo and 25% ab-key techniques. Given the evolution of surgical techniques and populations over time, analyses accounted for heterogeneity in outcome reporting. Across all studies, the average qualified success rate was 72.3% (range: 33-97%) over follow-up periods of 6 to 132 months. Ab-interno approaches showed slightly higher efficacy and fewer complications. Durability varied, with reduced outcomes in refractory and advanced glaucoma. Complications such as hyphema, hypotony, and vision loss were infrequent. Notably, newer ab-interno techniques demonstrated improved outcomes in IOP reduction, safety, and procedural longevity.

Conclusion: Cyclodialysis remains a viable and effective surgical option for enhancing uveoscleral outflow in glaucoma management. While outcomes vary by patient severity and surgical technique, particularly with older methods, modern ab-interno approaches offer enhanced efficacy and safety-especially in mild to moderate cases.

Keywords: MIGS; cyclodialysis; glaucoma; interventional glaucoma treatment; uveoscleral outflow.