Minimally invasive glaucoma surgery as primary stand‐alone surgery for glaucoma

Abstract

Recently, many new devices and procedures have been developed to lower intraocular pressure in a less invasive and purportedly safer manner than traditional glaucoma surgery. These new devices might encourage an earlier transition to surgery and reduce the long-term commitment to topical glaucoma medications with their associated compliance and intolerance issues. Although often seen as an adjunct to cataract surgery, a growing body of evidence suggests that primary minimally invasive glaucoma surgery may be a viable initial treatment option. New studies have shown that primary ab interno trabeculectomy (Trabectome, NeoMedix Inc., Tustin, CA, USA), trabecular micro-bypass stent insertion (iStent and iStent Inject, Glaukos Corporation, Laguna Hills, CA, USA), canalicular scaffolding (Hydrus, Invantis Inc., Irvine CA, USA), the ab interno gel Implant (XEN, Allergan, Dublin, Ireland) or supraciliary stenting (CyPass Micro-Stent, Alcon, Fort Worth, TX, USA) may lower the lowering intraocular pressure and/or topical medication burden in phakic or pseudophakic patients with glaucoma. This effect seems to last at least 12 months but reliable cost-effectiveness and quality of life indicators have not yet been established by investigator-initiated randomized trials of sufficient size and duration.

XEN‐45 collagen implant for the treatment of uveitic glaucoma

“…Three eyes (12.5%) lost ≥2 lines of BCVA due to cataract progression after XEN‐45 stent implantation, likely secondary to the use of postoperative steroid eye drops. Despite the material of the XEN‐45 implant being soft and tissue‐conforming, implant exposure occurred in two eyes (8.3%) in our study and has also been reported previously …”

“…MIGS is typically characterized by a favourable safety profile, and this is the first report of serious and potentially sight‐threatening complications resulting from a MIGS device. Notably, these serious complications have not been reported after XEN‐45 implantation in eyes with primary open angle glaucoma . In comparison, ab interno trabeculectomy with the Trabectome was found to be effective for the treatment of uveitic glaucoma but was not associated with persistent hypotony or ocular infections .…”

“…Notably, these serious complications have not been reported after XEN-45 implantation in eyes with primary open angle glaucoma. [23][24][25] In comparison, ab interno trabeculectomy with the Trabectome was found to be effective for the treatment of uveitic glaucoma but was not associated with persistent hypotony or ocular infections. 26,27 In our study, there was a high rate of transient postoperative hypotony associated with a shallow anterior chamber, with approximately 20% of patients requiring anterior chamber reformation with viscoelastic.…”

Minimally invasive glaucoma surgery: Comparison of iStent with iStent inject in primary open angle glaucoma

“…In Australia, there has been a marked increase in MIGS uptake with Medicare data indicating an exponential increase in use over the last few years . Although MIGS is currently seen primarily as adjunct to cataract surgery, it is increasingly being considered as a viable initial treatment option …”

Two-Year Outcomes of Ab Interno Trabeculectomy with the Trabectome for Chinese Primary Open Angle Glaucoma: A Retrospective Multicenter Study

“…In contrast, microincisional glaucoma surgery provides a safe IOP reduction with a short recovery time [7], has become an ideal option for early to moderate POAG [8].…”