Minimally invasive glaucoma surgery: A comprehensive review

Abstract

Minimally Invasive Glaucoma Surgery (MIGS) has emerged as a major advancement in the management of glaucoma, providing a less invasive and safer alternative to traditional surgeries. Conventional glaucoma surgeries are typically reserved for patients with advanced glaucoma who are on “maximally tolerated medical therapy” or those with advanced disease. However, there is often a tendency to delay surgery because of the risk of potential complications of these invasive surgeries. MIGS is characterized by a high safety profile, with a lower risk of severe complications compared to traditional glaucoma surgeries. It is particularly suitable for patients with mild-to-moderate open-angle glaucoma. MIGS tends to bridge the therapeutic gap between medical management and traditional invasive surgeries. MIGS encompasses a variety of techniques and devices, such as Trabectome, iStent, Kahook Dual Blade, Gonioscopy-Assisted Transluminal Trabeculotomy (GATT), Hydrus, and minimally invasive bleb surgeries like PreserFlo Microshunt and Xen Implant. Post-operative recovery is generally quicker, with many patients experiencing improvements in their quality of life due to reduced medication dependence and faster healing.However, like all other interventions, MIGS is not without potential complications. Transient hyphema, IOP spikes, and device-related issues can occur. This review classifies MIGS procedures based on their anatomical targets, which include trabecular meshwork bypass, suprachoroidal space, and subconjunctival filtration.It explores the mechanisms, approaches, and clinical outcomes associated with different types of MIGS. A comprehensive literature search using PubMed was conducted, studies published between January 2000 and March 2023 were thoroughly read to gather insights into the evolving terminology, indications, contraindications, and classification of MIGS procedures. In conclusion, MIGS offers a promising alternative for glaucoma management, especially for patients with mild-to-moderate disease. Its safety, rapid recovery, and ability to reduce medication burdens make it a valuable addition to glaucoma armamentarium. However, further research and long-term studies are needed to fully establish the efficacy and safety of these innovative techniques.