Abstract
Glaucoma is a chronic neurodegenerative optic nerve disease. Treatment is intended to prevent the development and progression of optic nerve damage by lowering intraocular pressure (IOP). Current therapy options include topical/systemic drugs that increase aqueous humor outflow or decrease its production, laser therapy that targets the trabecular meshwork and ciliary body, and incisional surgery. Trabeculectomy as well as glaucoma drainage devices are often performed, given their high efficacy in lowering IOP. However, the significant risk profile with potential sight-threatening complications has motivated glaucoma experts to create alternative surgeries to treat glaucoma. Minimally invasive glaucoma surgery (MIGS) is defined by: micro-invasive approach, minimal tissue trauma, high safety profile, and rapid recovery. The new devices might promote an earlier transition from medical/laser therapy to surgery, and therefore decrease the side effects associated with long-term use of topical medications as well as deal with the limited adherence of patients to their regimens. This review presents the surgical options available for glaucoma patients and their evolution over the past 25 years.
Highlights
Glaucoma is the second leading cause of blindness worldwide,[1] and its chronic nature requires treatment throughout the patient’s lifetime
Intraocular pressure (IOP) is currently the only known modifiable risk factor,[2] most existing therapeutic modalities have a common goal of reducing IOP via medications, laser, or surgery
Considering that glaucoma is a neurodegenerative chronic disease, the goal of glaucoma treatment and surgery is preserving the quality of life (QOL) of the patients, and their independence.[46]
Summary
Glaucoma is the second leading cause of blindness worldwide,[1] and its chronic nature requires treatment throughout the patient’s lifetime. Intraocular pressure (IOP) is currently the only known modifiable risk factor,[2] most existing therapeutic modalities have a common goal of reducing IOP via medications, laser, or surgery. Surgery is typically performed when non-invasive efforts (maximal tolerated medical therapy and/or laser trabeculoplasty) have been exhausted and are incapable of reaching target IOP levels (IOP levels preventing further visual field damage). For patients with milder diseases, MIGS potentially broaden the therapeutic options that were usually only non-invasive, while traditional surgeries will keep targeting patients with more advanced disease.[7] There are three main aqueous outflow pathways which have been the center of attention for MIGS devices: Schlemm’s canal improving trabecular outflow, the suprachoroidal space improving the uveoscleral outflow, and the subconjunctival space creating an alternative outflow pathway. The purpose of this review is to summarize surgical procedures available for glaucoma patients, their indication, efficacy, safety, cost-effectiveness, and how they fit together in the overall management of glaucoma patients (Table 1)
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