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Minimally invasive trabecular meshwork surgery for open-angle glaucoma
Kalyan Vemulapalli1, Rishikesh Gandhewar2, Tsz Wing Yim3
1Department of Ophthalmology, Royal Berkshire NHS Trust, Reading, UK.
The Cochrane Database of Systematic Reviews
|July 21, 2026
Summary
Minimally invasive Schlemm's canal surgery (SC-MIGS) shows uncertain benefits for glaucoma patients. While it may increase medication-free status short-term compared to phacoemulsification alone, it carries a higher bleeding risk and offers limited advantages over other MIGS or non-MIGS surgeries.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Intraocular Pressure Management
Background:
- Glaucoma is a leading cause of irreversible blindness, necessitating effective intraocular pressure (IOP) management.
- Minimally invasive glaucoma surgery (MIGS) techniques, specifically those targeting Schlemm's canal (SC-MIGS), aim to optimize IOP control and slow glaucoma progression.
- This review updates and expands upon previous research on SC-MIGS for open-angle glaucoma.
Purpose of the Study:
- To evaluate the efficacy and safety of SC-MIGS compared to medical, laser, or other surgical treatments for open-angle glaucoma.
- To assess outcomes including medication-free status, IOP reduction, visual field progression, and adverse events.
Main Methods:
- A systematic review of randomized controlled trials (RCTs) was conducted, searching multiple databases up to October 2025.
- Included RCTs compared SC-MIGS procedures (e.g., goniotomy, canaloplasty) against non-MIGS, other MIGS, laser, or medical therapy.
- Data synthesis involved meta-analysis where possible, or narrative summaries for heterogeneous data, using Cochrane methodology.
Main Results:
- Evidence for SC-MIGS versus non-MIGS surgery showed no significant short-term differences in medication-free status or IOP.
- SC-MIGS combined with phacoemulsification may increase short-term medication-free participants but also increases bleeding risk compared to phacoemulsification alone.
- Comparisons between SC-MIGS and other SC-MIGS or laser treatments yielded limited evidence of significant differences, though SC-MIGS may offer greater IOP reduction versus laser.
Conclusions:
- The current evidence for SC-MIGS is of low to very low certainty, leading to weak conclusions.
- SC-MIGS shows potential for increased medication-free status short-term when combined with phacoemulsification, but with an elevated risk of bleeding.
- SC-MIGS may provide a greater IOP reduction compared to laser treatment, but overall benefits and risks require further investigation.
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