Purpose Interest in micro-invasive glaucoma surgery (MIGS) has exploded over the last 8 years with an increase in MIGS procedures of at least 400% in the United States, according to Medicare data. MIGS is an umbrella term that can cover many different types of surgeries. This review focuses on peer-reviewed evidence for Trabectome®, iStent inject®, Kahook Dual Blade®, XEN® Gel Stent, and Hydrus®. Methods We present key recent studies evaluating the efficacy and safety of MIGS in various types of glaucoma patients with different stages of disease. Conclusion We conclude that MIGS is generally safe and efficacious, although only some MIGS have been studied through randomized clinical trials. When comparing and contrasting the different MIGS procedures, large prospective studies are not yet the norm. High-quality large prospective studies involving MIGS will be an important next step as ophthalmologists decide how to incorporate MIGS into their surgical armamentarium.

https://www.tandfonline.com/doi/pdf/10.1080/08820538.2021.1903513

Microinvasive Glaucoma Surgery: An Evidence-Based Review.

Purpose To report the long-term efficacy of endoscopic cyclophotocoagulation (ECP) in pediatric glaucoma following cataract surgery (GFCS). Methods ECP was performed on 35 eyes of 25 patients 24 mm Hg, alternative glaucoma procedure following ECP, or occurrence of visually significant complications. Analysis was performed to estimate risk factors for failure. Results A total of 27 aphakic and 8 pseudophakic eyes were included. Pretreatment IOP averaged 33.9 ± 7.9 mm Hg. Final IOP after a mean follow-up period of 7.2 years was 18.9 ± 8.8 mm Hg (P  Conclusions In this patient cohort, with average follow-up period of 7.2 years, ECP was useful in the treatment of pediatric GFCS.

Long-term efficacy of endoscopic cyclophotocoagulation in the management of glaucoma following cataract surgery in children

http://www.mcpiqojournal.org/article/S2542454822000686/pdf

Updates on the Diagnosis and Management of Glaucoma

Juvenile-onset Open-angle Glaucoma - A Clinical and Genetic Update.

Juvenile-onset open-angle glaucoma – A clinical and genetic update

Cyclodestruction aims to reduce aqueous humor production through the coagulation or destruction of the ciliary body and has been an important treatment choice for glaucoma since the 1930s. The purp...

https://www.tandfonline.com/doi/pdf/10.1080/08820538.2020.1810711

A Review of Cyclodestructive Procedures for the Treatment of Glaucoma.

BACKGROUND/OBJECTIVE To report the initial outcomes of phacoemulsification, endoscopic cyclophotocoagulation, and dual blade ab interno trabeculectomy (PEcK), and compare them to those of phacoemulsification, endoscopic cyclophotocoagulation, and trabecular micro-bypass stent insertion (ICE-1). SUBJECTS/METHODS Patients from January 2018 to December 2019 that underwent PEcK or ICE-1 at a tertiary referral centre were included in this retrospective comparative case series. Patients were excluded if they had additional concomitant procedures, less than 6 weeks (42 days) of follow-up or were not at least 18 years old. Intraocular pressure (IOP), number of glaucoma medications, and best-corrected visual acuity were collected preoperatively and postoperatively at 6 weeks, 3, 6, and 12 months. Kaplan-Meier survival analysis and Cox proportional-hazards regression were conducted to elucidate any factors associated with survival time. RESULTS The mean preoperative IOP was 18.3 ± 5.9 mmHg in the PEcK group (53 eyes) and 14.7 ± 4.3 mmHg in the ICE-1 group (23 eyes) (p = 0.004) on 3.3 ± 1.3 and 1.7 ± 0.93 glaucoma medications (p < 0.001), respectively. Twelve months postoperatively the mean IOP reduction was 5.1 ± 4.4 mmHg and 2.3 ± 4.0 mmHg (p = 0.08), and the mean medication reduction was 1.6 ± 1.5 and 0.97 ± 0.66 (p = 0.10), in the PEcK and ICE-1 groups, respectively. Kaplan-Meier survival analysis did not reveal any differences in treatment survival. CONCLUSIONS Both PEcK and ICE-1 provide clinically relevant reductions in IOP and glaucoma medication burden, however the PEcK procedure may confer greater reductions in IOP. The procedures did not differ with regard to Kaplan-Meier survival probability.

/pdf/outcomes-of-phacoemulsification-and-endoscopic-3r4lbyiivd.pdf

Outcomes of phacoemulsification and endoscopic cyclophotocoagulation performed with dual blade ab interno trabeculectomy or trabecular micro-bypass stent insertion.

Purpose. To compare the effectiveness and safety of 360° and 180° of Selective Laser Trabeculoplasty (SLT) for the treatment of elevated intraocular pressure (IOP). Methods. Retrospective cohort study. The main outcome measure was the Kaplan–Meier analysis comparing the cumulative probabilities of survival between the 360° and 180° SLT groups in terms of IOP reduction. Success was defined as ≥20% IOP reduction from baseline with an IOP between 5–18 mmHg and ≤1 glaucoma medication added postoperatively. Additional outcome measures included changes in average IOP, number of glaucoma medications, and the incidence of postoperative IOP spikes. Measurements were obtained at 6 weeks, 1 year, and 2 years postoperatively. Results. Two hundred and fifty-eight eyes of 258 patients were included in the 360° group, and 196 eyes of 196 patients were included in the 180° group. The mean IOP reductions at 2 years were 2.21 ± 2.02 mmHg and 2.43 ± 1.81 mmHg ( ) in the 180° and 360° groups, respectively. There were no significant differences in the incidence of postoperative IOP spikes between the two groups. There was a significant difference in the survival curves of the two groups ( ). The Cox proportional-hazard model indicated that 360° of SLT application was a significant predictor of long-term success ( ). Conclusions. 360° of SLT application seems to provide for greater long-term IOP control than 180° of application without putting patients at an elevated risk for postoperative IOP spikes.

/pdf/effectiveness-of-selective-laser-trabeculoplasty-applied-to-3ff7ogjy4c.pdf

Effectiveness of Selective Laser Trabeculoplasty Applied to 360° vs. 180° of the Angle.

Purpose: To compare the effectiveness and safety of augmented vs. traditional Micropulse transscleral cyclophotocoagulation (MP-TSCPC) settings in the treatment of glaucoma.
Methods: Retrospective case-control study. The main outcome measures were the Kaplan-Meier analyses comparing the cumulative probabilities of survival between the augmented and traditional MP-TSCPC groups in terms of IOP and glaucoma medication reduction. Augmented MP-TSCPC consisted of treatment with a higher mean power, longer duration, and use of both sweeping and stopand-continue techniques. Additional outcome measures included changes in average IOP, number of glaucoma medications, visual acuity, and the prevalence of complication rates. Measurements were obtained at 1 day, 1 week, 6 weeks, 3 months, 6 months, and 1 year postoperatively.
Results: 45 eyes of 45 patients were included in the augmented MP-TSCPC group, and 45 eyes of 45 patients were included in the traditional MP-TSCPC group. The mean IOP reductions at 1 year were 7.93 ± 10.05 mm Hg and 7.55 mm Hg (p=0.9) in the augmented and traditional MP-TSCPC groups, respectively. There were no significant differences in the prevalence of complications reported at any postoperative visits. There was a significant difference between the survival curves of the augmented and traditional MP-TSCPC in terms of both IOP reduction (p=0.041), and glaucoma medication reduction (p=0.037).
Conclusions: Augmented MP-TSCPC appears to provide for greater long-term IOP control than traditional MP-TSCPC without compromising safety.

/pdf/augmented-mp-tscpc-for-the-management-of-elevated-iop-in-4ysbvtclt2.pdf

Augmented MP-TSCPC for the management of elevated IOP in glaucomatous eyes

The purpose of the current case is to report the successful management of juvenile-onset open-angle glaucoma with bilateral XEN Gel Stent (Allegran Inc., Irvine, CA) implantation in a patient first diagnosed during pregnancy with co-existing dysautonomia. Treatment with the XEN Gel Stent provided dramatic reductions in intraocular pressure (IOP), and glaucoma medications sustained up to 23 months postoperatively. The success of this case may suggest that this minimally invasive procedure could be an effective treatment option for younger patients who require substantial reductions in IOP and glaucoma medication burden.

/pdf/bilateral-xen-gel-stent-implantation-in-juvenile-onset-open-1783r3apmd.pdf

Emma Klug

Papers

A Review of Cyclodestructive Procedures for the Treatment of Glaucoma.

Outcomes of phacoemulsification and endoscopic cyclophotocoagulation performed with dual blade ab interno trabeculectomy or trabecular micro-bypass stent insertion.

Effectiveness of Selective Laser Trabeculoplasty Applied to 360° vs. 180° of the Angle.

Augmented MP-TSCPC for the management of elevated IOP in glaucomatous eyes

Bilateral XEN Gel Stent Implantation in Juvenile-Onset Open-Angle Glaucoma.