AGS 2025: Clemens Strohmaier, PhD, on improving aqueous humour outflow following excimer laser trabeculostomy

At the 2025 American Glaucoma Society (AGS) Annual Meeting, held from February 26 to March 2 in Washington, DC, US, Clemens A. Strohmaier, PhD, presented research on improvements in aqueous humour outflow following the Elios procedure. His study utilised aqueous humour angiography, a technique pioneered by Alex A. Huang, MD, PhD, at the Shiley Eye Institute in San Diego, California. Strohmaier’s poster was recognised as a Top Poster Presentation by AGS.

Aqueous humour angiography involves infusing specialised dyes into the anterior chamber, allowing real-time visualisation of outflow patterns before and after the procedure in live patients. The study consistently demonstrated improved outflow across all examined cases, further supporting Elios' potential in enhancing the effectiveness of minimally invasive glaucoma surgery (MIGS).

One of the study’s key goals was to explore the variability in efficacy observed in MIGS procedures, despite their established safety. Supported by Elios, the research aims to optimise trabecular bypass surgery by identifying the most effective placement strategies. Interestingly, the study found that improved outflow did not always occur precisely at the site of laser energy application, challenging conventional assumptions about direct trabecular bypass-outflow correlation. Instead, the enhancement was observed in adjacent areas, prompting further investigation.

Building on these findings, an ongoing clinical study is applying insights from Huang’s lab to determine whether targeting low-flow regions of the trabecular meshwork results in better surgical outcomes. Preliminary lab results suggest improved efficacy when these areas are treated, with the clinical trial expected to confirm this approach.

Strohmaier emphasised that while the Elios procedure is a simple, safe, and effective way to improve outflow, broader challenges remain in translating MIGS success from laboratory research to clinical practice. He also suggested that episcleral circulation might play a limiting role in MIGS efficacy—an area requiring further exploration through advanced angiographic techniques. These findings contribute to the development of more precise, patient-specific surgical strategies aimed at optimising glaucoma treatment outcomes.