Trends in glaucoma surgery: an evolving landscape

Abstract

AbstractPurposeThe introduction of microinvasive glaucoma devices (MIGS), and changes in healthcare demands in consequence to the COVID‐19 pandemic, glaucoma surgeons have been required to evolve traditional practice techniques. We aimed to study trends in glaucoma surgery over a 5‐year period.MethodsElectronic medical records for patients undergoing glaucoma surgical procedures were retrieved at our centre between January 2016 and March 2021. Data on demographics, co‐morbidities, aetiology of disease, ocular parameters and outcomes were retrieved. Changes in clinical guidelines and surgeon related preferences were compared at all time points. Trends in surgical practice including variance in the utilisation of MIGS surgery were studied.ResultsA total of 4028 operations were included. The mean age was 69.5 (SD 12.8). No significant variance in sex was seen (M:F 2061:1967). Trabeculectomies comprised of 10.2% (n = 411), glaucoma drainage devices (GDD) 2.8% (n = 111) and MIGS 22.2% (n = 895) of all operations performed. A 61.4% and 60.3% reduction in number of trabeculectomies and GDD’s was seen respectively between 2016 and 2020. There was a significant increase in the utilisation of MIGS (+293%) and combined procedures (+10%). A significant proportion of these novel procedures included endo‐cyclophotocoagulation (n = 178) and iStents (n = 642). During the COVID‐19 pandemic there appeared to be marked increase in the number of Preserflo implantations in comparison to trabeculectomies and GDD surgeries (+850% increase of Preserflo between 2019 and 2020, 9.4% and 54.6% decline for trabeculectomies and GDD’s respectively).ConclusionsMIGS is becoming increasingly established as an effective tool in the glaucoma surgeons’ armamentarium. This is due to shorter surgical time, recovery periods and cost‐effectiveness of MIGS procedures. This continues to be an evolving landscape, with the advancement of canal‐based and subconjunctival MIGS procedures.