Minimally Invasive Glaucoma Surgery (MIGS) in Open Angle Glaucoma: An Updated Systematic Review and Meta-Analysis
Authors: Shawn Yuan1, Georges Durr1, Joseph Panarelli2. 1Université de Montréal, 2NYU Langone Provider.
Author Disclosures: S. Yuan: None. G. Durr: Any direct financial payments including receipt of honoraria; Name of for-profit or not-for-profit organization(s); Alcon Laboratories Inc., Allergan Inc., Glaukos Corporation, Johnson and Johnson, Labticion Ophthalmics Inc., MicroSurgical Technology, Novartis Pharma AG, Santen Inc., Sight Sciences Inc.. Any direct financial payments including receipt of honoraria; Description of relationship(s); Speaker and/or Consultant. J. Panarelli: None.
Abstract Body:
Purpose: To summarize and compare long term clinical outcomes of different MIGS procedures (iStent, iStent inject, Trabectome, Kahook Dual Blade (KDB), Ab-Interno Canaloplasty (ABiC), XEN Gel Stent, PreserFlo, Hydrus, Excimer Laser Trabeculostomy (ELT), Gonioscopy-Assisted Transluminal Trabeculotomy (GATT)), both alone and with phacoemulsification.
Study Design: Meta-analysis and systematic review
Methods: A search to capture all MIGS clinical outcome studies was conducted and registered on PROSPERO (CRD42022360834). Studies were included if patients were affected by open-angle glaucoma and 1-year post-op outcomes were reported. Non-clinical studies, overlapping patient populations, case reports, studies on congenital or uveitic glaucoma were excluded. Primary outcomes were pre- and post- op intraocular pressures (IOP) and number of antiglaucoma drops. Data was pooled and analyzed according to primary mechanisms of action (e.g., canal stenting vs stripping) to determine the efficacy and safety of each MIGS class. Subgroup analyses were also performed for each MIGS device, whether a MIGS was combined with phaco vs standalone, and pre-op glaucoma severity, as determined by visual field (MD).
Results: A total of 162 studies and 17819 eyes with post-op 1-year outcomes were analyzed. Studies reporting medication-washout IOP measurements were rare and thus reductions in IOP and drops were analyzed in conjunction. Eyes with canal stenting MIGS (n=5021) had a pre-op IOP of 18.5±4.5mmHg on 1.8±0.9 drops and a 1-year post-op IOP of 14.9±3.4mmHg on 0.7±0.9 drops. Canal cutting MIGS (n=8361) had a pre- and post- op IOP of 22.2±6.6mmHg on 2.6±1.2 drops and 15.4±3.7mmHg on 1.9±1.3 drops respectively. GATT eyes (n=1284) had a pre-op IOP of 24.8±6.6mmHg on 3.0±0.9 drops and a post-op IOP of 14.2±3.7mmHg on 1.0±1.1 drops. Eyes receiving subconjunctival MIGS (n=2262 eyes) had a pre-op IOP of 22.4±6.2mmHg on 2.8±1.0 drops and post-op IOP of 14.2±4.3mmHg on 0.9±1.0 drops. Lastly, eyes undergoing ABiC had a pre-op IOP of 22.1±5.0mmHg on 2.4±0.9 drops and a post-op IOP of 14.5±3.1 mmHg on 0.7±0.9 drops. Sight-threatening complications were rare (<0.1%). Up to 6.8% of patients required further glaucoma surgery within 1 year.
Conclusions: Many new MIGS options have become available in recent years and offer surgeons a wide range of options to individualize patient care. The IOP and drops reduction was greater in the MIGS group than in the control group (e.g., phacoemulsification alone) in all studies. All MIGS analyzed were effective in safely lowering IOP and medication usage.
