Complications of micro-invasive glaucoma surgery.
Yook Eunmee, Vinod Kateki, Panarelli Joseph F
AI Summary
MIGS complications were reviewed. Despite improved safety, MIGS can cause malpositioning, elevated IOP, and transient hypotony, highlighting the need for careful patient selection and monitoring.
Abstract
Purpose of review: Micro-invasive glaucoma surgery (MIGS) is gaining favor with both comprehensive ophthalmologists and glaucoma specialists due in part to its improved safety profile when compared to traditional incisional glaucoma surgery. Despite a micro-invasive approach and minimal induced tissue trauma, each MIGS procedure is associated with unique complications. The present article summarizes evidence from the 2016 to 2017 review period regarding the safety profiles of Schlemm's canal-based, suprachoroidal, and subconjunctival microstents.
Recent findings: Ab-interno microstents are subject to intraoperative malpositioning, which can result in luminal obstruction and decreased efficacy. Acutely elevated intraocular pressure (IOP) has been observed with the iStent (Glaukos Corp., Laguna Hills, CA, USA; 2-4.3%), Hydrus Microstent (Ivantis Inc., Irvine, CA, USA; 6%), Cypass Microstent (Alcon, Fort Worth, TX, USA; 3-10.8%), and Xen Gel Stent (Allergan Plc, Dublin, Ireland; 21.5%). Meanwhile, most cases of hypotony (IOP < 6 mmHg) occurred within the first postoperative month, resolved with conservative treatment and without further surgical intervention, and were not associated with vision-threatening sequelae.
Summary
Interest in MIGS continues to grow as these procedures allow surgeons to intervene earlier in the disease course for patients with milder stages of glaucoma. Complications associated with MIGS, albeit infrequent and mostly transient, do occur despite a less invasive approach than trabeculectomy and tube shunt surgery.
MeSH Terms
Shields Classification
Key Concepts5
Micro-invasive glaucoma surgery (MIGS) is associated with unique complications despite its micro-invasive approach and minimal induced tissue trauma.
Ab-interno microstents are subject to intraoperative malpositioning, which can result in luminal obstruction and decreased efficacy.
Acutely elevated intraocular pressure (IOP) has been observed with the iStent (Glaukos Corp.) in 2-4.3% of cases, Hydrus Microstent (Ivantis Inc.) in 6% of cases, Cypass Microstent (Alcon) in 3-10.8% of cases, and Xen Gel Stent (Allergan Plc) in 21.5% of cases.
Most cases of hypotony (IOP < 6 mmHg) following micro-invasive glaucoma surgery occurred within the first postoperative month, resolved with conservative treatment without further surgical intervention, and were not associated with vision-threatening sequelae.
Complications associated with micro-invasive glaucoma surgery (MIGS), although infrequent and mostly transient, occur despite a less invasive approach than trabeculectomy and tube shunt surgery.
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