Trabecular Meshwork-Based MIGS: Efficacy, Technique Variability, and Wound Healing-A Comprehensive Review.

Area of Science:

• Ophthalmology
• Surgical Innovation
• Glaucoma Management

Background:

• Glaucoma is a leading cause of global blindness, often requiring surgical intervention when medical treatments fail.
• Trabecular meshwork (TM)-based micro-invasive glaucoma surgery (MIGS) presents a less invasive alternative for lowering intraocular pressure (IOP).

Purpose of the Study:

• To review and synthesize current scientific literature and clinical trials on various TM-based MIGS techniques.
• To evaluate the efficacy, safety, and outcomes of different TM-based MIGS procedures.

Main Methods:

• A narrative review of scientific literature and clinical trials.
• Analysis of TM-based MIGS techniques including stents, goniotomy, trabeculotomy, electrocautery, laser, and ab interno canaloplasty.
• Examination of efficacy, medication reduction, safety, complications, and success factors.

Main Results:

• All reviewed TM-based MIGS devices demonstrated significant IOP reduction compared to trabeculectomies.
• TM-based MIGS exhibit a favorable safety profile relative to traditional glaucoma surgeries.
• Common complications include transient hyphema, corneal edema, and anterior chamber inflammation.

Conclusions:

• TM-based MIGS are a safe and effective surgical option for eligible glaucoma patients requiring moderate IOP reduction.
• Surgical success is influenced by technique, device selection, and patient-specific factors.
• Future research should investigate long-term outcomes, comparative device effectiveness, and mechanistic insights of MIGS.