Microinvasive glaucoma surgery: A review of 3476 eyes

Surv Ophthalmol. 2021 Sep-Oct;66(5):714-742. doi: 10.1016/j.survophthal.2020.09.005. Epub 2020 Sep 28.


Microinvasive glaucoma surgery (MIGS) is a potentially safer and more efficacious method studied in patients with mild-to-moderate open-angle glaucoma requiring less invasive treatment goals; however, the literature on MIGS must be thoroughly evaluated. We conducted a review of MIGS by searching MEDLINE, EMBASE, and Cochrane CENTRAL. Primary efficacy indicators were reductions in intraocular pressure and topical medication use postoperatively. While all comparative randomized controlled trials assessing MIGS in English peer-reviewed journals were included, only observational studies with a target follow-up of at least one year and a high priority score were analyzed, resulting in a total of 3476 eyes across 20 trials. The mean age was 69.5 ± 2.9 years, 53.7% were female, and 77.4% were Caucasian. One study had last follow-up at less than one year, fifteen studies had follow-up extending 1-2 years, and four had longer than two years of follow-up. A pattern of more significant intraocular pressure and medication reduction was observed in patients who underwent MIGS (n = 2170) relative to control (n = 1306) interventions. iStent had the most literature supporting its efficacy, followed by Hydrus. The most common adverse events after MIGS implantation included stent obstruction, inflammation, and subsequent surgical intervention. Surgical complication rates and efficacy are favorable after MIGS. This review helps to consolidate the high-quality evidence that exists for various MIGS procedures and to identify gaps where further research is needed.

Keywords: IOP reduction; MIGS; filtration surgery; glaucoma surgery; ocular drainage implant; open-angle glaucoma.

Publication types

  • Review

MeSH terms

  • Aged
  • Female
  • Glaucoma, Open-Angle* / surgery
  • Humans
  • Intraocular Pressure
  • Tonometry, Ocular
  • Trabecular Meshwork / surgery
  • Treatment Outcome