Prospective Studies of Minimally Invasive Glaucoma Surgeries: Systematic Review and Quality Assessment

Abstract

Glaucoma is a common blinding disease; while there is no cure, effective treatments include medications, laser, and incisional surgery. There is significant interest from patients and doctors to develop safer surgical options throughout the spectrum of disease, to minimize treatment burden in mild glaucoma patients and to minimize risk of complications in patients needing more aggressive treatment. Surgical procedures called Minimally or Micro-Invasive Glaucoma Surgery (MIGS) are growing in popularity. Eighty-seven prospective studies on MIGS were identified and assessed for quality. Most (74%) did not have a control group. Twelve of the highest quality were reviewed. MIGS procedures appeared to have fewer complications, and lowered intraocular pressure, and reduced medication use. Studies were limited by small sample size, narrow spectrum of glaucomatous disease, and/or conflicts of interest. There is a need for high quality, independently funded and performed, comparative studies on the MIGS to help make treatment decisions.

Keywords: MIGS; ab interno; angle surgery; glaucoma treatment; microinvasive.

Figure 1

Quality Scores by Technology. This scattered column graph displays the quality scores of individual studies of the technologies and surgical techniques. Each manuscript was assessed using the quality scale shown in Table 1. The total score for each manuscript was plotted for each type of MIGS. The line indicates the median, where appropriate. Similar techniques were grouped together (*) for single and few manuscripts. Ultrasound-based procedures included high intensity focused ultrasound (HIFU) and ultrasonic circular cyclocoagulation (UC3). YAG gonio procedures included Er:YAG gonio puncture, and Er:YAG goniotomy. Trabecular-based procedures included ab-interno gonio trabeculotomy, ab interno trabeculectomy (with vitrectomy forceps), endoscopic trabecular surgery, irrigation/aspiration of the trabecular meshwork, suture trab 360. Diathermy-based procedures were intrastromal diathermal keratostomy (IDK).,25