ASCRS 2026: Evolving approaches to glaucoma surgery and complication management

A wide-ranging glaucoma session examined contemporary surgical techniques, complication management, and practical pearls for improving angle surgery outcomes at the 2026 American Society of Cataract and Refractive Surgery annual meeting, held April 10 to 12, in Washington, DC.

Oluwatosin U. Smith, MD, who co-moderated the session along with Jason Bacharach, MD, highlighted a broad surgical program focused on both newer glaucoma procedures and practical approaches to managing complications from established surgeries, with particular attention to angle-based techniques and hypotony management. She described the session as notable for balancing innovation with complication management. “It was an exciting session because not only did we visit some new procedures that are out there, but we spent some time also looking at how to treat or address complications of some of the older surgeries.”

A major focus was the diagnosis and repair of cyclodialysis clefts, which she noted can occur as complications of angle-based surgery and are increasingly relevant as minimally invasive glaucoma surgery (MIGS) continues to expand. The discussion included multiple surgical approaches to cleft repair. According to Smith, the video content demonstrated “different approaches to repairing a cleft,” ranging from less technically demanding options, such as placing “a CTR in the sulcus space,” to more complex “direct visualization repair of a cyclodialysis cleft.” The session also addressed procedures in which a cyclodialysis cleft is intentionally created, with emphasis on the surgical steps involved.

Management of hypotony following drainage implant surgery was another key topic. Smith highlighted the use of “a Prolene suture, two Prolene suture to stent the tube ab interno without having to revise the entire procedure,” presenting it as a less invasive alternative to full surgical revision.

A recurring theme was the evolution toward less invasive management strategies for complications. As Smith put it, “It’s like a minimally invasive approach to complications versus … the standard traditional ways we have done them in the past.” She noted that new instrumentation, refined techniques, and practical intraoperative “pearls” are improving both primary procedures and revision strategies.

The session also covered technical refinements in device implantation within the anterior chamber angle, including discussion of iDose, iStent, and Hydrus placement. Importantly, the emphasis extended beyond procedural basics to improving surgical fluency in the angle, with discussion centered on techniques that help surgeons “actually [be] a better surgeon in the angle.”

For early-career surgeons and trainees, Smith highlighted the value of video-based instruction on hands-free gonioprism use in MIGS and practical angle surgery techniques. She also pointed to goniosynechialysis performed under gonioscopic visualization as an important option in patients with angle closure undergoing cataract extraction.

Overall, the session provided what Smith described as “good exposure to glaucoma as a whole,” spanning newer procedures, complication repair, and technical strategies aimed at making surgeons more effective in contemporary glaucoma surgery.