Complications After Incisional/Excisional Minimally Invasive Glaucoma Surgery-An Update and Literature Review

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Surgical Complications

Background:

• Minimally invasive glaucoma surgery (MIGS) offers a less invasive approach to managing glaucoma.
• Stent-less MIGS procedures, including gonioscopy-assisted transluminal trabeculotomy (GATT), bent needle goniectomy (BANG), Kahook-dual blade goniotomy, and microincisional trabeculectomy (MIT), are increasingly utilized.
• Understanding potential complications is crucial for patient safety and surgical planning.

Purpose of the Study:

• To comprehensively review and discuss the various complications associated with stent-less incisional or excisional MIGS procedures.
• To highlight potential intraoperative and postoperative adverse events.
• To emphasize the importance of vigilance in managing these procedures.

Main Methods:

• A systematic review of published literature on stent-less MIGS complications.
• Analysis of reported complications from 2014 to 2024.
• Inclusion of procedures such as GATT, BANG, Kahook-dual blade goniotomy, and MIT.

Main Results:

• Common complications include hyphema, peripheral anterior synechiae, and intraocular pressure spikes.
• Vision-threatening complications such as cyclodialysis, Descemet's detachment, corneal edema, iridodialysis, vitreous loss, and vitreous hemorrhage can occur.
• These complications may arise during or after incisional or excisional MIGS.

Conclusions:

• Despite being minimally invasive, stent-less MIGS procedures carry risks of significant complications.
• Awareness of all potential adverse events is essential for surgeons.
• Careful surgical technique and management throughout all stages are necessary to mitigate risks and ensure optimal patient outcomes.