Minimally Invasive Glaucoma Surgical Techniques for Open-Angle Glaucoma: An Overview of Cochrane Systematic Reviews...

Area of Science:

• Ophthalmology
• Surgical Innovation
• Evidence-Based Medicine

Background:

• Glaucoma impacts over 75 million globally, with intraocular pressure (IOP)-lowering surgery as a key treatment.
• Minimally invasive glaucoma surgeries (MIGS) have emerged to reduce surgical morbidity.
• Comparative effectiveness and safety data for MIGS are crucial for clinical decision-making.

Purpose of the Study:

• To systematically review randomized clinical trials on MIGS for open-angle glaucoma.
• To synthesize findings from existing Cochrane reviews evaluating MIGS effectiveness and safety.

Main Methods:

• Searched the Cochrane Database of Systematic Reviews for studies published before June 1, 2021.
• Included reviews comparing MIGS with cataract surgery alone, other MIGS, traditional surgery, laser trabeculoplasty, or medical therapy.
• Extracted data following PRISMA guidelines, assessed methodological rigor using AMSTAR 2, and performed random-effects network meta-analyses.

Main Results:

• Six Cochrane reviews covered various MIGS, including trabecular bypass (iStent, Hydrus), ab interno trabeculotomy, and drainage devices.
• Moderate evidence suggests Hydrus microstents improve sustained drop-free glaucoma control and IOP reduction compared to cataract surgery alone.
• iStents also improved drop-free control, but IOP-lowering effects were not sustained; CyPass microstents improved control but increased vision loss risk.

Conclusions:

• Some MIGS may enhance drop-free glaucoma control compared to cataract surgery alone.
• Current randomized trial data indicate Hydrus microstents offer superior drop-free control and IOP lowering versus iStents, albeit with small effect sizes.
• Understanding MIGS comparative effectiveness is vital for optimizing glaucoma management.