Endothelial cell loss associated with minimally invasive glaucoma surgery

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Cornea Research

Background:

• Minimally invasive glaucoma surgery (MIGS) offers a safer alternative for intraocular pressure control.
• The CyPass Micro-Stent's market withdrawal highlighted concerns regarding MIGS-associated cornea endothelial cell (CEC) loss.
• This review synthesizes current evidence on CEC loss following MIGS procedures.

Purpose of the Study:

• To review and summarize recent evidence on cornea endothelial cell (CEC) loss associated with minimally invasive glaucoma surgery (MIGS).
• To compare CEC loss in patients undergoing combined MIGS and phacoemulsification versus phacoemulsification alone.

Main Methods:

• Systematic review of prospective clinical trials and retrospective observational studies.
• Analysis of studies published between 2011 and 2021 reporting 12-month CEC loss data.
• Comparison of CEC loss rates between 'phaco-plus' procedures and phacoemulsification alone.

Main Results:

• Short-term (12-month) CEC loss in combined MIGS and phacoemulsification ranged up to 14.6%.
• Phacoemulsification alone reported CEC loss rates between 12.8% and 15.2% in recent trials.
• No MIGS combined with phacoemulsification, except for the CyPass Micro-Stent, showed significantly higher short-term CEC loss than phacoemulsification alone.

Conclusions:

• Current evidence suggests no significant short-term increase in CEC loss with most MIGS combined with phacoemulsification compared to phacoemulsification alone.
• Longer-term follow-up studies are necessary to definitively evaluate the impact of 'phaco-plus' procedures on CEC loss.
• Further research is required to understand the long-term safety profile of MIGS regarding corneal health.