Recent Advancements in Glaucoma Surgery-A Review

Abstract

Surgery has long been an important treatment for limiting optic nerve damage and minimising visual loss in patients with glaucoma. Numerous improvements, modifications, and innovations in glaucoma surgery over recent decades have improved surgical safety, and have led to earlier and more frequent surgical intervention in glaucoma patients at risk of vision loss. This review summarises the latest advancements in trabeculectomy surgery, glaucoma drainage device (GDD) implantation, and minimally invasive glaucoma surgery (MIGS). A comprehensive search of MEDLINE, EMBASE, and CENTRAL databases, alongside subsequent hand searches-limited to the past 10 years for trabeculectomy and GDDs, and the past 5 years for MIGS-yielded 2283 results, 58 of which were included in the final review (8 trabeculectomy, 27 GDD, and 23 MIGS). Advancements in trabeculectomy are described in terms of adjunctive incisions, Tenon's layer management, and novel suturing techniques. Advancements in GDD implantation pertain to modifications of surgical techniques and devices, novel methods to deal with postoperative complications and surgical failure, and the invention of new GDDs. Finally, the popularity of MIGS has recently promoted modifications to current surgical techniques and the development of novel MIGS devices.

Keywords: device; eye; glaucoma; glaucoma tube shunts; minimally invasive glaucoma surgery; trabeculectomy.

Figure 1

PRISMA flowchart [6].

Figure 2

(A) The making of a partial-thickness scleral flap to create a deep crater; (B) further dissection of the scleral block to create an even deeper crater; (C) cyclodialysis cleft made using cyclodialysis spatula; and (D) deep scleral tissue inserted at the cyclodialysis cleft. Courtesy of Dada et al. [13].

Figure 3

Creation of an 8 mm half-thickness scleral tunnel (top); passage of shunt tube through the scleral tunnel (bottom). Courtesy of Eslami et al. [35].

Figure 4

(a) The distal-to-limbus tunnel is prepared with a bevel-up lancet between the two scleral incisions; (b) the proximal-to-limbus tunnel is fashioned from the proximal-to-limbus incisions to the limbus; (c) a paracentesis is created with a 23-gauge needle through the proximal-to-limbus tunnel into the anterior chamber; (d) the tube is secured with a 10-0 nylon suture (distal incision-sclera, sclera-distal incision). Courtesy of Brouzas et al. [36].

Figure 5

(top) The lamellar scleral tunnel was created with a crescent blade for the passage of the AGV tube. (bottom) Insertion of the tube in the sulcus. Courtesy of Prakavan et al. [37].

Figure 6

(a) The MicroMT consists of an expanded polytetrafluoroethylene membrane (white arrow) and silicone tube (blue arrow) with an intraluminal stent (green arrow); (b) the stent can be retracted after the operation. Courtesy of Ahn et al. [65].

Figure 7

Preserflo Microshunt implanted into the posterior chamber. Note the orientation of the bevel to avoid incarceration of the iris. Courtesy of Martinez-de-la-Casa et al. [81].

Figure 8

MINIject glaucoma drainage device (iSTAR Medical SA, Wavre, Belgium): (A) implant made of STAR material; (B) schematic of the device in situ. Courtesy of Denis et al. [100].