Current Developments in Glaucoma Surgery and MIGS

AbstractGlaucoma is a progressive optic neuropathy that is the second leading cause of preventable blindness worldwide, after cataract formation. A rise in the intraocular pressure (IOP) is considered to be a major risk factor for glaucoma and is associated with an abnormal increase of resistance to aqueous humour outflow from the anterior chamber. Glaucoma drainage devices have been developed to provide an alternative pathway through which aqueous humour can effectively exit the anterior chamber, thereby reducing IOP. These devices include the traditional aqueous shunts with tube-plate design, as well as more recent implants, such as the trabeculectomy-modifying EX-PRESS® implant and the new minimally invasive glaucoma surgery (MIGS) devices. In this review, we will describe each implant in detail, focusing on their efficacy in reducing IOP and safety profile. Additionally, a critical and evidence-based comparison between these implants will be provided. Finally, we will propose potential developments that may help to improve the performance of current devices.

Download Full-text

A One-Piece Ocular Drainage Implant for Glaucoma Surgery: A Preliminary Report

Acta Veterinaria Scandinavica ◽

10.1186/bf03547297 ◽

1992 ◽

Vol 33 (4) ◽

pp. 317-324

Author(s):

M. Kivalo ◽

C. Raitta ◽

T. Mononen

Keyword(s):

Preliminary Report ◽

Glaucoma Surgery

Download Full-text

Incidence of steroid response in microinvasive glaucoma surgery with trabecular microbypass stent and ab interno trabeculectomy

Canadian Journal of Ophthalmology ◽

10.1016/j.jcjo.2021.04.008 ◽

2021 ◽

Author(s):

Maryam Abtahi ◽

Chris J. Rudnisky ◽

Samir Nazarali ◽

Karim F. Damji

Keyword(s):

Glaucoma Surgery ◽

Steroid Response ◽

Ab Interno Trabeculectomy ◽

Ab Interno

Download Full-text

Comparison of Efficacy between 120° and 180° Schlemm’s Canal Incision Microhook Ab Interno Trabeculotomy

Journal of Clinical Medicine ◽

10.3390/jcm10143181 ◽

2021 ◽

Vol 10 (14) ◽

pp. 3181

Author(s):

Naoki Okada ◽

Kazuyuki Hirooka ◽

Hiromitsu Onoe ◽

Yumiko Murakami ◽

Hideaki Okumichi ◽

...

Keyword(s):

Surgical Outcomes ◽

Open Angle Glaucoma ◽

Case Series ◽

Glaucoma Surgery ◽

Success Rates ◽

Schlemm’S Canal ◽

Schlemm's Canal ◽

Kaplan Meier ◽

The Mean ◽

Ab Interno

We compared surgical outcomes in patients with either primary open-angle glaucoma or exfoliation glaucoma after undergoing combined phacoemulsification with either a 120° or 180° incision during a Schlemm’s canal microhook ab interno trabeculotomy (μLOT-Phaco). This retrospective comparative case series examined 52 μLOT-Phaco eyes that underwent surgery between September 2017 and December 2020. Surgical qualified success was defined as an intraocular pressure (IOP) of ≤20 mmHg, ≥20% IOP reduction with IOP-lowering medications, and no additional glaucoma surgery. Success rates were evaluated by Kaplan-Meier survival analysis. The number of postoperative IOP-lowering medications and occurrence of complications were also assessed. Mean preoperative IOP in the 120° group was 16.9 ± 7.6 mmHg, which significantly decreased to 10.9 ± 2.7 mmHg (p < 0.01) and 11.1 ± 3.1 mmHg (p = 0.01) at 12 and 24 months, respectively. The mean number of preoperative IOP-lowering medications significantly decreased from 2.8 ± 1.4 to 1.4 ± 1.4 (p < 0.01) at 24 months. Mean preoperative IOP in the 180° group was 17.1 ± 7.0 mmHg, which significantly decreased to 12.1 ± 3.2 mmHg (p = 0.02) and 12.9 ± 1.4 mmHg (p = 0.01) at 12 and 24 months, respectively. The mean number of preoperative IOP-lowering medications significantly decreased from 2.9 ± 1.2 to 1.4 ± 1.5 (p < 0.01) at 24 months. The probability of qualified success at 24 months in the 120° and 180° groups was 50.4% and 54.6%, respectively (p = 0.58). There was no difference observed for hyphema formation or IOP spikes. Surgical outcomes were not significantly different between the 120° and 180° incisions in Schlemm’s canal.

Download Full-text