Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jul 19:18:2125-2136.
doi: 10.2147/OPTH.S465828. eCollection 2024.

MIGS in Severe Glaucoma: 12-Month Retrospective Efficacy and Safety of Microinvasive Glaucoma Surgery with Cataract Extraction

Blake Oberfeld  1   2 , Fatemeh Golsoorat Pahlaviani  1 , Hani El Helwe  1 , Henisk Falah  1 , Nathan Hall  1 , Jonathan Trzcinski  1 , David Solá-Del Valle  1   3   4
Affiliations

MIGS in Severe Glaucoma: 12-Month Retrospective Efficacy and Safety of Microinvasive Glaucoma Surgery with Cataract Extraction

Blake Oberfeld et al. Clin Ophthalmol. .

Abstract

Purpose: Despite holding promise, reports of using MIGS in severe glaucoma are scarce, and none has described combining multiple MIGS in this population. To the best of our knowledge, this is the largest study to report outcomes of phacoemulsification and MIGS (Phaco/MIGS) in patients with severe glaucoma.

Methods: This retrospective review comprised 327 clinical visits of 71 patients with severe glaucoma who underwent Phaco/MIGS with iStent, endocyclodestruction, Kahook Dual Blade, Hydrus Microstent, or a combination of these MIGS (cMIGS) performed between 2016 and 2021. Primary outcomes included intraocular pressure (IOP) and medication burden evaluated by Generalized Estimating Equations, as well as Kaplan-Meier Estimates. Further analyses compared the efficacy of cMIGS and single Phaco/MIGS (sMIGS), procedure duration, visual acuity, and complications.

Results: Mean preoperative IOP was 16.7 mmHg ± 5.8 (SD) on 2.3 ± 1.9 medications overall (N = 71), 16.9 ± 6.3 mmHg on 1.7 ± 1.9 medications in the sMIGS group (N = 37), and 16.4 ± 5.3 mmHg on 2.9 ± 1.6 medications in the cMIGS group (N = 34). Throughout 12 months, Phaco/MIGS led to significant reduction patterns in IOP (p < 0.001) and medications (p = 0.03). At 12 months, 47.5%, 87.5%, and 64.7% of the patients achieved IOP ≤ 12 mmHg, 17 mmHg, or predetermined goal IOP, respectively, without additional medication or procedure. Mean 12-month IOP was 13.5 ± 3.1 mmHg on 1.8 ± 1.7 medications. After adjusting for baseline medication burden, the reduction pattern in IOP (p < 0.05) was different between cMIGS and sMIGS, favoring cMIGS, and the groups had similar reduction patterns in medications (p = 0.75).

Conclusion: The use of Phaco/MIGS in patients with cataract and severe glaucoma may significantly reduce IOP and medication burden throughout 12 months and, thus, may serve as a stepping stone in severe glaucoma patients with visually significant cataract before proceeding with more invasive glaucoma surgery. This effect may be potentiated by the combination effect of cMIGS.

Keywords: GEE; MIGS; cMIGS; combined MIGS; combined efficacy; comparative effectiveness; generalized estimating equations; microinvasive glaucoma surgery; severe glaucoma.

Plain language summary

Many patients with cataract and mild or moderate glaucoma who undergo cataract surgery also benefit from microinvasive glaucoma surgery (MIGS) performed at the same time, but the role of MIGS in patients with severe glaucoma and cataract is not clear. We report that combined cataract surgery and MIGS were associated with significant reductions in eye pressure in patients with severe glaucoma for more than 12 months.

PubMed Disclaimer

Conflict of interest statement

D.S.D. is a consultant for AbbVie, New World Medical and BVI Medical and on the advisory board for Glaukos. No other conflicting relevant relationship exists for any author.

Figures

Figure 1
Figure 1
Survival Curves.
Figure 2
Figure 2
Survival Curves Stratified by Single or Combined MIGS.
See this image and copyright information in PMC

References

    1. Nichani P, Popovic MM, Schlenker MB, Park J, Ahmed IIK. Microinvasive glaucoma surgery: a review of 3476 eyes. Surv Ophthalmol. 2021;66(5):714–742. doi: 10.1016/j.survophthal.2020.09.005 - DOI - PubMed
    1. Vold S, Ahmed IIK, Craven ER, et al. Two-year compass trial results: supraciliary microstenting with phacoemulsification in patients with open-angle glaucoma and cataracts. Ophthalmology. 2016;123(10):2103–2112. doi: 10.1016/j.ophtha.2016.06.032 - DOI - PubMed
    1. Craven ER, Katz LJ, Wells JM, Giamporcaro JE; iStent Study Group. Cataract surgery with trabecular micro-bypass stent implantation in patients with mild-to-moderate open-angle glaucoma and cataract: two-year follow-up. J Cataract Refract Surg. 2012;38(8):1339–1345. doi: 10.1016/j.jcrs.2012.03.025 - DOI - PubMed
    1. Hengerer FH, Auffarth GU, Riffel C, Conrad-Hengerer I. Prospective, non-randomized, 36-month study of second-Generation trabecular micro-bypass stents with phacoemulsification in eyes with various types of glaucoma. Ophthalmol Ther. 2018;7(2):405–415. doi: 10.1007/s40123-018-0152-8 - DOI - PMC - PubMed
    1. Samuelson TW, Chang DF, Marquis R, et al. A schlemm canal microstent for intraocular pressure reduction in primary open-angle glaucoma and cataract: the horizon study. Ophthalmology. 2019;126(1):29–37. doi: 10.1016/j.ophtha.2018.05.012 - DOI - PubMed

LinkOut - more resources