Bio-Rx Cyclodialysis training summary
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Preparation & precautions
Understand the pathway Controlled separation at the scleral spur creates access to the uveoscleral space; scleral allograft reinforces the opening.
Plan anesthesia The supraciliary space is sensitive. Select appropriate anesthesia; the deck lists topical, intracameral, regional blocks, general anesthesia and MAC.
Review angle and axial length The deck flags angle closure and axial length >26 mm as precautions. Most available data cited in the deck involve 23–26 mm eyes.
Takeaway: Rev E recommends a miotic for the first 10 cases. Confirm patient-specific planning against current IFU and training.
Material and mechanism
scleral allograft uses minimally modified scleral tissue described as flexible, porous, bio-conforming and homologous. These are material/design descriptions, not proof of superiority to other implants.
The uveoscleral route passes through, around and between tissues. The deck defines cyclodialysis as controlled separation of longitudinal ciliary muscle fibers from the scleral spur.
Anesthesia and precautions
Deck-listed options: topical or intracameral anesthesia, sub-Tenon, peribulbar or retrobulbar block, general anesthesia, and monitored anesthesia care/sedation. No single agent or dose is specified.
Axial length 23–26 mm describes the majority of available data cited, not an independently established indication boundary. The deck does not supply a complete contraindication list.
Clinical context, separate from technique
Page 19 cites Ianchulev et al., Clin Ophthalmol. 2024;18:3605–3614, DOI 10.2147/OPTH.S496631. Its visit means are baseline 20.2 mmHg (n=117), Month 1 15.1 (n=115), Month 6 14.6 (n=100) and Month 12 13.9 (n=105). These are changing visit populations.
Page 20 summarizes the 31-eye two-year series: >70% achieved ≥20% IOP reduction on the same/fewer agents, >55% medication reduction, and no serious ocular AEs reported. These are deck summaries, not an individual prognosis. Calvo et al., Ophthalmology Science. 2025;5:100727, DOI 10.1016/j.xops.2025.100727.
Source note: Source-derived training summary. Indications, contraindications and device-specific handling must be checked against current IFU.
Page 3 · AlloSert Uveo platform · Reference 2–6, 19–20, 22Angle visualization
Position the head and scope Rotate the patient’s head approximately 20° and the microscope approximately 30°. Increase magnification as needed.
Identify the correct plane Clearly identify the scleral spur and ciliary body band in an open angle.
Maintain layer visibility The approach should support controlled separation of the ciliary body from the spur and implantation in the intended plane.
Takeaway: Do not transfer Bio-Rx Canaloplasty’s head-rotation ranges or canal-entry plane to this procedure.
Read the supplied anatomy reference
SL: Schwalbe’s line. TM: trabecular meshwork. SS: scleral spur. CBB: ciliary body band. The supplied image pairs the gonioscopic view with a schematic placement plane.
Visualization requirement
The deck recommends under-rotating the head relative to trabecular procedures. It does not define a mandatory Shaffer grade or a three-clock-hour viewing threshold.
Page 8 emphasizes an open angle and sufficient magnification to see the tissue layers during dissection.
Source note: Source page 8 supplies angle-visualization guidance. The still image is illustrative and does not establish calibrated operative geometry.
Page 8 · Angle illustration · Reference 7–8Controlled cleft creation
Select the controlled opening The deck lists 1.50–1.75 mm for two allografts and 0.75–1.0 mm for one. Avoid clock hours 3 and 9.
Engage and dissect Engage the scleral spur with an anterior bias, then gently strum down to separate the ciliary body from the spur.
Use visco-cycloplasty as needed Standard cohesive OVD may tamponade heme and augment the cleft.
Takeaway: Creation of the cleft and scleral reinforcement are distinct procedural steps.
Instrument and dimensions
Page 10 describes AlloSert Uveo or a secondary instrument for controlled cyclodialysis. Pages 11–12 illustrate spatula/Spannula use.
The dimensional ranges are reproduced in millimeters. The deck does not define an alternative clock-hour conversion, a posterior depth specification or a broader sizing algorithm.
Visco-cycloplasty
Page 13 lists cohesive OVD for tamponade of heme and cleft augmentation when needed. Page 10 also permits OVD to assist allograft position after the procedural steps as needed.
Source note: Keep these Rev E dimensions separate from earlier advisory-board descriptions. No alternate funnel geometry or posterior depth is inferred.
Page 11 · Cleft-creation still · Reference 10–13Allograft deployment
Enter lateral to the cleft Initiate implantation lateral to the cyclodialysis and confirm that the delivery tip is on plane.
Advance the clear tip Advance the full clear cannula-tip length to the metal-sheath junction, creating the uveoscleral track posterior to the limbus.
Depress and retract the slider With the hand fixed, move only the finger. Watch the blue filament–tissue junction remain stationary as the plastic sheath retracts.
Takeaway: The Bio-Rx Cyclodialysis sequence retracts the sheath around stationary filament and tissue; it is not Bio-Rx Canaloplasty’s green-sleeve button sequence.
Deployment confirmation
Rev E asks the operator to focus where the blue filament meets the scleral allograft. It describes zero movement of filament and tissue during plastic-sheath retraction.
Confirm that the slider fully retracts and the blue filament becomes fully exposed, as shown on page 15.
The still illustrates the release stage. A completed loading or assembly sequence is not provided in this deck.
Source note: Use source page 14 for the fixed-hand, stationary-filament release sequence. The still does not specify numerical posterior penetration depth.
Page 14 · Allograft-deployment still · Reference 14–15Final position & adjustment
Confirm complete release Ensure the actuation slider is fully retracted and the blue filament fully exposed.
Inspect the final allograft position Rev E states the final scleral allograft position should extend 0.5 mm or less into the anterior chamber.
Reposition when indicated During I&A, if protrusion appears >0.5 mm, rotate the head and reposition before closing. Visco-cycloplasty may assist position as needed.
Takeaway: The supplied Rev E limit is ≤0.5 mm into the AC. Keep it distinct from absolute “zero protrusion” wording in other materials.
Too deep, but still visible
Page 23 describes using a cystotome to “pluck” tissue anterior when implantation is too deep yet visible in the cleft. This is the source’s adjustment maneuver, not a complete retrieval algorithm.
The deck does not provide instructions for an invisible/displaced allograft, failed retrieval, or corneal contact. Obtain the current approved handling guidance rather than extrapolating.
During irrigation and aspiration
Page 23 notes that a small portion of tissue may be visible. It directs head rotation and repositioning before closure for apparent AC protrusion >0.5 mm.
Use the stated threshold with the source positioning guidance. The image is not a calibrated measurement tool.
Source note: The ≤0.5 mm instruction is specific to PN 900121 Rev E. Confirm consistency with current IFU and later training revisions.
Page 15 · Positioning still · Reference 10, 15, 23Situations
Know the example regimen Steroid 4-3-2-1 weekly taper over four weeks; antibiotic twice daily for one week. The source does not specify drug or concentration.
Coordinate glaucoma therapy Page 17 advises regular glaucoma medications for at least a month, then stopping aqueous suppressants first. Page 22 ties continuation to completion of the steroid regimen.
Review additional situations The FAQ advises avoiding Kenalog injections and close immediate postoperative IOP follow-up when a drug-eluting device is present.
Takeaway: Treat the deck regimen as an example for surgeon-directed care; reconcile medication changes with IOP, steroid duration and current instructions.
What the source specifies
Steroid example: four times daily for week 1, three times daily for week 2, twice daily for week 3 and once daily for week 4. Antibiotic: BID for week 1 in addition to the steroid regimen.
The source does not identify agents, concentrations, taper exceptions or a universal schedule for every patient.
Page 22 explicitly advises avoiding Kenalog injections in scleral allograft patients and continuing current ocular hypotensive therapy until the steroid regimen is completed.
Combination-device context
Page 23 advises closely following IOP in the immediate postoperative period when a drug-eluting device is present.
The same page makes a J-code combination statement. Coding does not establish clinical compatibility or coverage; that assertion is not adopted as a verified billing instruction here.
Situations not resolved by this deck
There is no complete management algorithm for IOP elevation, hypotony, significant bleeding, invisible/displaced tissue or failed release. Do not infer those algorithms from the brief positioning FAQ.
Page 16 references a surgical video courtesy of Dr. Arkadiy Yadgarov. The supplied PDF does not provide a playable embedded video or a resolvable video link; no playable video is included in this module.
Source note: Example postoperative instructions are reproduced from the supplied deck, not newly prescribed. Drug choice, exceptions and escalation need surgeon-specific review.
Page 4 · scleral allograft illustration · Reference 17, 22–23