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
Review
. 2025 Jan 10;122(1):23-30.
doi: 10.3238/arztebl.m2024.0240.

Minimally Invasive Glaucoma Surgery

Bogomil Voykov  1 , Verena Prokosch, Jan Lübke
Affiliations
Review

Minimally Invasive Glaucoma Surgery

Bogomil Voykov et al. Dtsch Arztebl Int. .

Abstract

Background: Approximately 1.4 % of the German population aged 35 to 74 suffers from glaucoma, which is one of the more common causes of blindness. The only evidence-based treatment option at present is lowering the intraocular pressure. Modern minimally invasive surgical procedures hold out the prospect of lowering the intraocular pressure without the risk of serious complications.

Methods: This is a selective review of pertinent publications retrieved by a search in PubMed, including randomized, controlled trials and meta-analyses.

Results: The intraocular pressure can be lowered with eyedrops, laser procedures, and surgery. Trabeculectomy is the reference standard in glaucoma surgery but leads to complications in 3-15% of cases. In minimally invasive glaucoma surgery, very small stents can be implanted to lower the intraocular pressure. These proce - dures have a better safety profile but are only indicated for mild or moderate glaucoma. The Kahook Dual Blade, iStent inject, and Hydrus Microshunt procedures have been studied in randomized, controlled trials. An additional pressure-lowering effect beyond that of cataract surgery was demonstrated only for the latter two procedures (1.9 mmHg and 1.8 mmHg, respectively). Other procedures have only been investigated in cohort studies to date; a pressure-lowering effect was found for some of them. Moreover, iStent and Hydrus Microshunt have been found to slow the progression of visual field defects.

Conclusion: There are robust data documenting the effect of iStent and Hydrus Microshunt in lowering the intraocular pressure and lessening the need for eyedrops. High-quality controlled trials are still needed to test the efficacy of other procedures.

PubMed Disclaimer

Figures

Figure 1
Figure 1
The anterior chamber of the eye with the structures relevant to the outflow of aqueous humor.
Figure 2
Figure 2
Schematic depiction of a) Kahook Dual Blade b) excimer-laser trabeculotomy c) iStent d) Hydrus Microshunt e) Miniject implant
See this image and copyright information in PMC

References

    1. Crabb DP, Smith ND, Glen FC, Burton R, Garway-Heath DF. How does glaucoma look?: patient perception of visual field loss. Ophthalmology. 2013;120:1120–1126. - PubMed
    1. EGS. European Glaucoma Society Guidelines. 2021
    1. Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014;121:2081–2090. - PubMed
    1. Höhn R, Nickels S, Schuster AK, et al. Prevalence of glaucoma in Germany: results from the Gutenberg Health Study. Graefes Arch Clin Exp Ophthalmol. 2018;256:1695–1702. - PubMed
    1. GBD 2019 Blindness and Vision Impairment Collaborators; Vision Loss Expert Group of the Global Burden of Disease. Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study. Lancet Glob Health. 2021;9 e144-60.

MeSH terms