By Billy Pan, MD, and Priya Desai, MD
Early-Experience Users, AlloFlo Uveo Limited Control Release
The Unmet Need
Many MIGS patients experience a gradual loss of IOP control over time, which after years of increasing medication burden often leads to discussions about bleb-forming procedures. In our limited control release experience with AlloFlo Uveo, surgeons have identified a new option to help these patients without leaving the angle or sacrificing the conjunctiva. AlloFlo Uveo leverages the uveoscleral outflow system, providing a durable, bleb-free alternative that may extend the suecess of angle surgery while addressing a pathway primarily only accessible through medication.
Reclaiming Control Without a Bleb – Dr. Priya Desai
Patient Profile: my first AlloFlo Uveo patients included two men and one woman, all with moderate to severe glaucoma who had previously undergone cataract surgery and MIGS. Despite being on multiple medications, their glaucoma continued to progress with noticeable visual field loss.
Decision Rationale: These patients were frightened of going blind and struggling with compliance on multiple daily drops. Their eyes were red and irritated, and even with aggressive management, their glaucoma was worsening. They needed an option that avoided drainage tubes, or conjunctival manipulation.
Procedure: I was initially concerned about potential bleeding, retinal trauma, and post-operative IOP spikes similar to what we saw with earlier supraciliary technologies. However, I found incorporating AlloFlo Uveo into my operation room to be highly intuitive. The procedure took just 5-10 minutes, and the soft, flexible scleral tissue proved non-traumatic and confirmed nicely to the surrounding anatomy.
Outcome: All three patients experienced significant pressure drops with remarkably easy recovery. Over a year later, they’re still doing well. One patient is completely off drops, while the other two have reduced their medications by one.
“We’ve taken the scary concept of cyclodialysis and transformed it into an elegant, controlled procedure that helps our glaucoma patients when the effect of MIGS start to wane.” – Dr. Priya Desai
Enhancing Total Physiologic Outflow – Dr. Billy Pan
Patient Profile: I typically identify AlloFlo Uveo candidates pseudophakic patients with prior angle-based MIGS who still require multiple medications. A perfect example is a 68-year-old African-American male with moderate primary open-angle glaucoma in both eyes who had undergone cataract extraction and canaloplasty at age 64. Despite this intervention, his left eye pressure remained elevated at 19 mmHg using both Latanoprost and Cosopt. His right eye was better controlled at 12 mmHg on the same medication regimen.
Decision Rationale: When trabecular MIGS procedures don’t provide adequate control, we’ve traditionally had to jump directly to conjunctival procedures, using up our limited conjunctival “real estate.” Having an intermediate option that targets and entirely different outflow system that is natural to the eye gives us more “shots on goal” against this lifelong disease.
Procedure: The learning curve for AlloFlo Uveo is surprisingly quick—most anterior segment surgeons will feel comfortable after just 3-5 cases. The procedure involves use of scleral spacers to create and hold open a cyclodialysis cleft. The procedure is performed in the same angle we’re already familiar with from MIGS surgeries, making it approachable for surgeons comfortable with gonioscopy-guided procedures.
Outcome: We’re seeing significant and enduring effects, with pressure control maintained over time. For the patient mentioned above, on year after AlloFlo Uveo treatment in his left eye, his IOP decreased to 14 mmHg with using only Latanoprost—eliminating the need for Cosopt. In my practice, the treatment paradigm has evolved to: drops/SLT, to trabecular MIGS, to AlloFlo Uveo, to filtering surgery, filling a crucial gap in our treatment options.
“The ideal AlloFlo Uveo patients are your pseudophakic, post-MIGS procedure patients. Once you begin to see pressures creep back up don’t wait to enhance the second natural outflow pathway sooner than later.” – Dr. Billy Pan
Natural Outflow Doesn't Stop with MIGS
These experiences reflect a growing clinical recognition that MIGS doesn't have to be the end of the road for natural outflow enhancement. We're now identifying AlloFlo candidates more proactively—patients with prior MIGS, early signs of waning efficacy, and a strong desire to push back traditional surgery. This bio-interventional technology opens a new pathway for glaucoma care by addressing the uveoscleral outflow system that has previously only been accessible through medication. With AlloFlo Uveo, we can now fight glaucoma in the OR with "both hands" instead of having one tied behind our back.
With AlloFlo Uveo, we can stay in the angle longer and delay—or even avoid—the need for filtering surgery while still offering our patients complete physiologic outflow enhancement.
