Microinvasive glaucoma surgeries: critical summary of clinical trial data with and without phacoemulsification.
Curr Opin Ophthalmol 2023;
34:146-151. [PMID:
36730753 DOI:
10.1097/icu.0000000000000923]
[Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW
To critically summarize and examine published data from randomized controlled clinical trials (RCTs) investigating the safety and efficacy of microinvasive glaucoma surgeries (MIGS) with and without cataract surgery versus cataract surgery alone.
RECENT FINDINGS
Three RCTs with standardized outcomes and rigorous methodology demonstrate superiority of the iStent (Glaukos), CyPass (Alcon), and Hydrus (Alcon) MIGS devices in combination with cataract surgery versus cataract surgery alone. The trials all involved medication washouts at baseline and also after 24 months of follow-up. In each of the trials, a greater proportion of participants randomized to the combined MIGS procedures achieved at least 20% unmedicated intraocular pressure (IOP) lowering compared with cataract surgery alone. With the exception of the CyPass device, which has been voluntarily withdrawn from the market, adverse events associated with MIGS were acceptable and consistent with routine intraocular surgeries. Follow-up studies demonstrate sustained efficacy, greater probabilities of visual field preservation, increased cost-effectiveness, and enhanced quality of life associated with MIGS procedures.
SUMMARY
Data related to MIGS platforms for treatment of open-angle glaucoma with or without co-existing cataract supports their continued adoption in clinical practice. Future studies comparing various techniques and devices in a standardized fashion are needed.
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