Product information and disease description Place of product in therapy Approaches to treatment Current treatment options and standard of care

Minimally invasive and incisional glaucoma surgery

6 evidence topics · 5 sources

AAO Preferred Practice Pattern: MIGS compared with traditional surgery

“Traditional glaucoma surgery generally produces greater IOP reduction than MIGS but also has a higher risk of complications.” (opens the source at this quote in a new tab)
“Modest IOP reduction has been reported following MIGS, and postoperative pressures are typically in the mid to upper teens.” (opens the source at this quote in a new tab)
“They are commonly combined with phacoemulsification; some are FDA approved only to be performed concurrently with phacoemulsification.” (opens the source at this quote in a new tab)
“These trials generally enrolled patients with mild to moderate OAG with elevated IOP.” (opens the source at this quote in a new tab)

European Glaucoma Society guidelines: MIGS indications and contraindications

“MIGS tend to have a modest IOP-lowering effect but can reduce the burden of medication, although the latter is not in line with the traditional aim of glaucoma surgery.” (opens the source at this quote in a new tab)
“These techniques mainly aim to reduce the IOP and/or the medication burden in patients with early to moderate open angle glaucoma or OHT.” (opens the source at this quote in a new tab)
“MIGS are not usually indicated for patients with advanced glaucoma, those needing lower target IOPs and those with angle closure.” (opens the source at this quote in a new tab)

Overview of Cochrane reviews of MIGS

“Moderate certainty evidence indicated that adding a Hydrus safely improved the likelihood of drop-free glaucoma control at medium-term (relative risk [RR], 1.6; 95% CI, 1.4 to 1.8) and long-term (RR, 1.6; 95% CI, 1.4 to 1.9) follow-up and conferred 2.0-mm Hg (95% CI, -2.7 to -1.3 mm Hg) greater IOP reduction at long-term follow-up, compared with cataract surgery alone. Adding an iStent also safely improved drop-free disease control compared with cataract surgery alone (RR, 1.4; 95% CI, 1.2 to 1.6), but the short-term IOP-lowering effect of the iStent was not sustained.” (opens the source at this quote in a new tab)

Trabeculectomy: AAO Preferred Practice Pattern

“Trabeculectomy remains the most effective surgical procedure to lower IOP; it is generally indicated when medications and appropriate laser surgery are insufficient to control disease and can be considered in selected cases as initial therapy.” (opens the source at this quote in a new tab)
“Estimates of success rates over time range from 31% to 88% in different populations and with varying definitions of success and failure.” (opens the source at this quote in a new tab)

TAGS: primary trabeculectomy versus medication in advanced glaucoma, 5 years

“The mean IOPs were 12.07 ± 5.18 mmHg and 14.76 ± 4.14 mmHg, respectively, and the mean difference was -2.56 (95% CI, -3.80 to -1.32; P < 0.001).” (opens the source at this quote in a new tab)
“At 5 years, the Treatment of Advanced Glaucoma Study demonstrated that primary trabeculectomy surgery is more effective in lowering IOP and preventing disease progression than primary medical treatment in patients with advanced disease and has a similar safety profile.” (opens the source at this quote in a new tab)

PTVT: tube shunt versus trabeculectomy, 5 years

“The cumulative probability of failure after 5 years of follow-up was 42% in the tube group and 35% in the trabeculectomy group (P = 0.21; hazard ratio = 1.31; 95% confidence interval = 0.86 to 2.01).” (opens the source at this quote in a new tab)