The need for research on minimally invasive glaucoma surgeries (MIGS) is at an all-time high considering the growing population of glaucoma patients worldwide has already reached 75 million. A recent meta-analysis focuses specifically on the disease’s most common form, open-angle glaucoma, and the effectiveness and safety of various MIGS procedures. 

The study analyzed data from six reviews in the Cochrane Database of Systematic Reviews. Included patients had one of the following: open-angle glaucoma, ocular hypertension or suspected glaucoma. Researchers compared MIGS interventions with cataract extraction alone or with other MIGS techniques, traditional glaucoma surgery, laser trabeculoplasty or medical therapy.

They found that some MIGS procedures, most notably the Hydrus and iStent implants, in addition to cataract surgery, may allow glaucoma patients greater drop-free disease control than cataract surgery alone. The now-discontinued CyPass microstent was also evaluated but was associated with an increased risk of vision loss. All three exhibited an IOP-lowering effect, but for patients who received iStent, the effect was less durable.

Adding one of the stents to a cataract procedure “may increase the likelihood of patients remaining drop-free at 6- to 18-month follow-up,” the authors of the study wrote. “For the Hydrus, moderate certainty evidence suggests that drop-free status is sustained at 24 months.” However, the authors emphasize that “these results should be understood in the context of the small absolute reduction in the number of IOP-lowering drops reported by each of the reviews: approximately half of one drop per day on average for each of the iStent (0.42), Hydrus (0.41), and CyPass (0.5).”

The authors also noted that health-related quality of life outcomes at 24 months and beyond need to be considered when conducting research in the field of MIGS and treating patients with glaucoma to reduce or remove the need for regular drops and ultimately improve their lives.

Bicket AK, Le JT, Azuara-Blanco A, et al. Minimally invasive glaucoma surgical techniques for open-angle glaucoma: an overview of Cochrane systematic reviews and network meta-analysis. JAMA Ophthalmol. July 15, 2021. Epub ahead of print.