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Complications of micro-invasive glaucoma surgery
Eunmee Yook1, Kateki Vinod, Joseph F Panarelli
1Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai and Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Purpose Of Review:
Micro-invasive glaucoma surgery (MIGS) is gaining favor with both comprehensive ophthalmologists and glaucoma specialists due in part to its improved safety profile when compared to traditional incisional glaucoma surgery. Despite a micro-invasive approach and minimal induced tissue trauma, each MIGS procedure is associated with unique complications. The present article summarizes evidence from the 2016 to 2017 review period regarding the safety profiles of Schlemm's canal-based, suprachoroidal, and subconjunctival microstents.
Recent Findings:
Ab-interno microstents are subject to intraoperative malpositioning, which can result in luminal obstruction and decreased efficacy. Acutely elevated intraocular pressure (IOP) has been observed with the iStent (Glaukos Corp., Laguna Hills, CA, USA; 2-4.3%), Hydrus Microstent (Ivantis Inc., Irvine, CA, USA; 6%), Cypass Microstent (Alcon, Fort Worth, TX, USA; 3-10.8%), and Xen Gel Stent (Allergan Plc, Dublin, Ireland; 21.5%). Meanwhile, most cases of hypotony (IOP < 6 mmHg) occurred within the first postoperative month, resolved with conservative treatment and without further surgical intervention, and were not associated with vision-threatening sequelae.
Summary:
Interest in MIGS continues to grow as these procedures allow surgeons to intervene earlier in the disease course for patients with milder stages of glaucoma. Complications associated with MIGS, albeit infrequent and mostly transient, do occur despite a less invasive approach than trabeculectomy and tube shunt surgery.
Insights
Micro-invasive glaucoma surgery (MIGS) offers a safer alternative to traditional procedures. While complications like elevated intraocular pressure (IOP) can occur, they are generally infrequent and transient, with hypotony resolving conservatively.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Medical Device Safety
Background:
- Micro-invasive glaucoma surgery (MIGS) is increasingly adopted due to its favorable safety profile compared to traditional incisional glaucoma surgery.
- Despite minimal tissue trauma, MIGS procedures carry unique potential complications.
Purpose of the Study:
- To review the safety profiles of Schlemm's canal, suprachoroidal, and subconjunctival microstents.
- To summarize evidence from 2016-2017 regarding MIGS safety.
Main Methods:
- Review of scientific literature from 2016-2017.
- Analysis of complication data for various MIGS devices.
Main Results:
- Ab-interno microstent malpositioning can lead to obstruction and reduced efficacy.
- Acute elevated intraocular pressure (IOP) rates varied among devices (e.g., Xen Gel Stent 21.5%).
- Hypotony was mostly transient, resolved conservatively, and did not cause vision loss.
Conclusions:
- MIGS is gaining popularity for early-stage glaucoma intervention.
- Complications, though infrequent and mostly transient, are associated with MIGS procedures.
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