Minimally invasive glaucoma surgery - current and emerging techniques to reduce intraocular pressure and medications

Krishna Komzak,Tze’Yo Toh,Penny Allen,Philip Rothschild,Joobin Hooshmand

doi:10.20517/2574-1225.2020.103

Abstract

Minimally invasive glaucoma surgery (MIGS) has become increasingly popular as a step in the management pathway of open angle glaucoma. Due to the relative novelty of these devices, there remains some paucity of evidence relating to their long-term efficacy and safety, and this can make comparison between these techniques somewhat complex. This review article aims to guide clinical decision making by providing the latest evidence on the comparative efficacy of current iterations of minimally invasive glaucoma surgery. A literature review was conducted to identify the most significant recent evidence to support the safety and efficacy of the various forms of minimally invasive glaucoma surgery. Included studies provided efficacy and safety data on a variety of minimally invasive glaucoma surgery methods. The PubMed database was searched and a total of 484 studies, published between 2015 and 2020 were identified, of which 27 were included. The studies indicate that most available forms of minimally invasive glaucoma surgery show statistically significant efficacy in terms of intra-ocular pressure reduction and improvement in medication burden, while maintaining an acceptable safety profile.

Highlights

Invasive glaucoma surgery (MIGS) is an emerging field in open angle glaucoma (OAG) management with a promise to offer a reduction in intra-ocular pressure (IOP) and medication burden without the comparatively high risk of complications associated with more invasive incisional procedures
Current established management options to reduce IOP primarily revolve around topical medications or application of selective laser trabeculoplasty (SLT) or a combination of both
The results showed a clear favourability for the IOP lowering effects of iStent with AbiC and phacoemulsification, as this group achieved a mean IOP reduction of 2.9 ± 3.6 mmHg compared with 1.7 ± 3.1 mmHg in the iStent and phacoemulsification groups alone

Summary

Introduction

Invasive glaucoma surgery (MIGS) is an emerging field in open angle glaucoma (OAG) management with a promise to offer a reduction in intra-ocular pressure (IOP) and medication burden without the comparatively high risk of complications associated with more invasive incisional procedures. Glaucoma is characterized by progressive optic neuropathy that is associated with progressive field loss in which IOP is a key modifiable factor. Current established management options to reduce IOP primarily revolve around topical medications or application of selective laser trabeculoplasty (SLT) or a combination of both. Patients will often require invasive and complicated surgery to avoid blindness. MIGS has heralded a new dawn in reducing IOP for glaucoma patients

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