Systematic Literature Review of Clinical, Economic, and Humanistic Outcomes Following Minimally Invasive Glaucoma Surgery or Selective Laser Trabeculoplasty for the Treatment of Open-Angle Glaucoma with or Without Cataract Extraction

Abstract

Introduction Selective laser trabeculoplasty (SLT) and minimally invasive glaucoma surgery (MIGS) are increasingly used options for mild-to-moderate open-angle glaucoma (OAG) care. While most MIGS devices are indicated for use in combination with cataract surgery only, with phacoemulsification playing a role in lowering IOP, newer technologies can also be used as standalone glaucoma surgery. Methods This systematic literature review (SLR) aimed to assess the clinical, economic, and humanistic outcomes of MIGS and SLT for the treatment of OAG and was conducted according to PRISMA guidelines. Studies that assessed MIGS or SLT in at least one treatment arm versus any other glaucoma treatment in adults with mild-to-moderate OAG were included. Clinical, humanistic (health-related quality of life [HRQoL] and patient burden), and economic data were extracted, and the methodological quality of included studies was evaluated. Results A total of 2720 articles were screened, and 81 publications were included. Fifty-eight reported clinical outcomes. The majority assessed iStent or iStent inject (n=41), followed by OMNI (n=9), gonioscopy-assisted transluminal trabeculotomy (GATT) or the Kahook Dual Blade (KDB) (n=7), Hydrus (n=6), SLT (n=5), Xen Gel Stent (n=2), PreserFlo (n=1), and iTrack (n=1). IOP reduction was observed across prospective studies, varying from −31% to −13.7% at month 6 and from −39% to −11.4% at year 1 versus baseline. Most adverse events were transient and non-serious. Limited humanistic and economic data were identified. Conclusion Given their established efficacy and safety, there is a rationale for wider use of MIGS in mild-to-moderate OAG. Of the MIGS devices, iStent and OMNI have the largest clinical evidence base supporting their sustained effectiveness.

Alternatives to Topical Glaucoma Medication for Glaucoma Management

“…Robust meta-analyses and systematic literature reviews of the MIGS family of surgeries collectively as a class have demonstrated significant reductions in both IOP and the need for IOP-lowering therapy when performed as standalone procedures or combined with cataract surgery. [137][138][139][140] These reviews report mean IOP reductions across the MIGS family in the 25-35% range, which is consistent with the expectations of primary topical medical therapy with a PGA. The fact that these MIGS IOP reductions are often accompanied by reductions in medication use-with meaningful proportions of patients being medication-free many years after surgery-suggests that the IOP reductions in non-medicated eyes could be even greater if medications were to be reintroduced.…”

Prospective Study of Canaloplasty and Trabeculotomy Performed by Trainees

“…Other potential risks of angle-based MIGS surgery include inadvertent damage to the cornea, iris, and other nearby structures with any device in the angle paired with an inexperienced gonio-surgeon. 12 , 20 , 21 This includes the possibility of creating an inadvertent cyclodialysis cleft with resultant hypotony. This complication has been reported with the OMNI procedure and a recent retrospective case series.…”

Introductory Chapter: Glaucoma Beyond 2020

“…Further, the success of trabeculectomy depends on the skill of the operating surgeon and requires advanced sub-specialty training in ophthalmology. The Minimally Invasive Glaucoma Surgery (MIGS) fulfills the role of surgical intervention that may be coupled with or without cataract extraction and does not cause a substantial increase in risk greater than that of the cataract extraction itself [33][34][35]. With these tenets, numerous MIGS devices that target various routes of outflow have been introduced.…”