Microinvasive Glaucoma Surgery: An Evidence-Based Review

Abstract

Purpose: Interest in micro-invasive glaucoma surgery (MIGS) has exploded over the last 8 years with an increase in MIGS procedures of at least 400% in the United States, according to Medicare data. MIGS is an umbrella term that can cover many different types of surgeries. This review focuses on peer-reviewed evidence for Trabectome ® , iStent inject ® , Kahook Dual Blade ® , XEN ® Gel Stent, and Hydrus ® . Methods: We present key recent studies evaluating the efficacy and safety of MIGS in various types of glaucoma patients with different stages of disease. Conclusion: We conclude that MIGS is generally safe and efficacious, although only some MIGS have been studied through randomized clinical trials. When comparing and contrasting the different MIGS procedures, large prospective studies are not yet the norm. High-quality large prospective studies involving MIGS will be an important next step as ophthalmologists decide how to incorporate MIGS into their surgical armamentarium.

Two-Year Outcome of Surgery in Glaucoma Patients

“…Recently, many minimally invasive surgical approaches have been introduced in order to avoid the number of postoperative complications in glaucoma surgeries 6 , 7 , 8 , 9 , 10 , 11 . Their effectiveness has been increasingly studied and compared to the “gold standard” in glaucoma surgery, the TE.…”

Corneal Endothelial Cell Loss in Patients After Minimally Invasive Glaucoma Surgery: Current Perspectives

“…The Kahook Dual Blade (KDB, New World Medical Inc., Rancho Cucamonga, California, USA) was introduced in 2015 as an ab interno goniotomy and trabeculectomy method. 6 It was designed to allow trabecular meshwork removal with minimal damage to adjacent tissues. It comprises a handle and sharp blade that allows gentle entrance into Schlemm’s canal at a 10° angle to the trabecular meshwork plane.…”

“…Since MIGS cannot extensively reduce the IOP as traditional incisional glaucoma surgery, they are mainly used for patients with mild-to-moderate glaucoma. 5 , 6 Specifically, MIGS are usually used to treat open-angle glaucoma (OAG), including primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PXG), and pigmentary glaucoma (PG). Additionally, there have been some papers of MIGS that have been used for primary angle-closure glaucoma (PACG), normal-tension glaucoma (NTG), and uveitic glaucoma; however, minimally invasive procedures are not routinely considered for these glaucoma types.…”

“…Additionally, there have been some papers of MIGS that have been used for primary angle-closure glaucoma (PACG), normal-tension glaucoma (NTG), and uveitic glaucoma; however, minimally invasive procedures are not routinely considered for these glaucoma types. 6 The incidence of complications depends on the type of surgical technique and ranges from 1% to 20%, with an approximate average of 3–5%. The most common early postoperative complication is anterior chamber hemorrhage.…”

Comparison of surgical outcomes between initial trabeculectomy and Ex-PRESS in terms of achieving an intraocular pressure below 15 and 18 mmHg: a retrospective comparative study

“…Therefore, ophthalmologists perform filtering surgery such as trabeculectomy (Trab) and Ex-PRESS (EX) device implantation are required to produce both high success rates and low IOPs. Xen [ 11 ] and Preserflo [ 12 ] have recently utilized implant devices like EX, which uses mitomycin C (MMC) and filtering of the aqueous humor into the subconjunctival spaces. Therefore, given the worldwide trend toward minimally invasive surgeries, the surgical outcomes of Trab and EX should be reconsidered to achieve lower IOP.…”