Long-Term Outcomes of Microinvasive Glaucoma Surgery (MIGS) vs.Trabeculectomy
DOI:
https://doi.org/10.63682/jns.v13i1.9236Keywords:
microinvasive glaucoma surgery, trabeculectomy, intraocular pressure, glaucoma surgery outcomes, bleb complications, long-term efficacyAbstract
Background: To compare the long-term efficacy and safety of Microinvasive Glaucoma Surgery (MIGS) and conventional trabeculectomy in patients with medically uncontrolled open-angle glaucoma.
Methods: This prospective comparative study was conducted from January 2023 to January 2024 and included 72 eyes of 72 patients (36 MIGS, 36 trabeculectomy). All participants underwent baseline ocular evaluation and were followed for 36 months. Primary outcome was mean intraocular pressure (IOP) reduction. Secondary outcomes included percentage of patients achieving target IOP (<15 mmHg), reduction in glaucoma medications, and postoperative complications. Data were analyzed using t-tests, Chi-square, and Kaplan–Meier survival curves with significance set at p<0.05.
Results: Both groups showed significant IOP reduction from baseline (p<0.001). Mean IOP reduction was greater in the trabeculectomy group (−9.8 ± 3.0 mmHg) compared to MIGS (−8.2 ± 2.7 mmHg, p=0.03). The proportion of patients achieving target IOP was higher with trabeculectomy (83.3% vs. 75.0%, p=0.39). Reduction in number of medications was comparable between groups (p=0.27). Complications such as hypotony and bleb leaks were significantly higher following trabeculectomy (p<0.05).
Conclusion: Both MIGS and trabeculectomy are effective in long-term IOP reduction, but trabeculectomy provides greater pressure lowering at the cost of more complications. MIGS offers a safer alternative with meaningful IOP control and reduced medication burden, making it suitable for patients with mild-to-moderate glaucoma or those at higher surgical risk.
Downloads
References
Geffen, N., et al., Minimally Invasive Micro Sclerostomy (MIMS) procedure: a novel glaucoma filtration procedure. 2022. 31(3): p. 191-200.
Islam, Y., et al., The indications for minimally invasive Glaucoma surgery, trabeculectomy, tube shunts, and cyclophotocoagulation in Glaucoma surgery. 2020. 5: p. 147-170.
Saeed, E., et al., The PreserFlo MicroShunt in the context of minimally invasive glaucoma surgery: a narrative review. 2023. 20(4): p. 2904.
Paletta Guedes, R.A., et al., Standalone Implantation of 2–3 trabecular micro-bypass stents (iStent inject±iStent) as an alternative to trabeculectomy for moderate-to-severe glaucoma. 2022. 11(1): p. 271-292.
Lund, U.H., et al., Minimally Invasive Glaucoma Surgery (MIGS) for individuals with glaucoma. A health technology assessment. 2021.
Pinto, L.A., G.S. Mégevand, and I.J.B.j.o.o. Stalmans, European Glaucoma Society–A guide on surgical innovation for glaucoma. 2023. 107(Suppl 1): p. 1-114.
Gambini, G., et al., PreserFlo® MicroShunt: an overview of this minimally invasive device for open-angle glaucoma. 2022. 6(1): p. 12.
Luo, N., et al., Comparison of tube shunt implantation and trabeculectomy for glaucoma: a systematic review and meta-analysis. 2023. 13(4): p. e065921.
Widder, R.A., et al., Trabectome, trabecular aspiration and phacoemulsification in a triple procedure for treating exfoliation glaucoma: A long-term follow-up. 2021. 31(5): p. 2432-2438.
Garg, A., Clinical and Patient-Reported Outcomes of Primary Selective Laser Trabeculoplasty in Open Angle Glaucoma & Ocular Hypertension. 2021, UCL (University College London).
Armstrong, J.J., et al., Ab externo SIBS microshunt with mitomycin C for open-angle glaucoma: three-year results as a primary surgical intervention. 2023. 6(5): p. 480-492.
Wong, W.D.A. and R. Lim, Surgical Management of Glaucoma in 2023: What’s New & What’s Still Working.
Komzak, K., et al., Minimally invasive glaucoma surgery-current and emerging techniques to reduce intraocular pressure and medications. 2021. 5: p. N/A-N/A.
Traverso, C.E., et al., Effectiveness and safety of xen gel stent in glaucoma surgery: a systematic review of the literature. 2023. 12(16): p. 5339.
Ramachandran, M., et al., Biomaterials for Glaucoma Surgery. 2023. 11(4): p. 92-103.
Gillmann, K., et al., Surgical management of pseudoexfoliative glaucoma: a review of current clinical considerations and surgical outcomes. 2021. 30(3): p. e32-e39.
Marcos-Parra, M.T., et al., Long-term effectiveness of XEN 45 gel-stent in open-angle glaucoma patients. 2023: p. 1223-1232.
Kalarn, S., T. Le, and D.J.J.C.O.i.O. Rhee, The role of trabeculectomy in the era of minimally invasive glaucoma surgery. 2022. 33(2): p. 112-118.
Olgun, A., et al., XEN Gel Stent versus trabeculectomy: short-term effects on corneal endothelial cells. 2021. 31(2): p. 346-353.
de Las Matas, R.B.-S., et al., Late-onset endophthalmitis after XEN45® implantation: a retrospective case series and literature review. 2021. 15(3): p. 153.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
