TY - JOUR
T1 - Minimally Invasive Glaucoma Surgery
T2 - Latest Developments and Future Challenges
AU - Chan, Poemen P.M.
AU - Larson, Mark D.
AU - Dickerson, Jaime E.
AU - Mercieca, Karl
AU - Koh, Victor Teck Chang
AU - Lim, Ridia
AU - Leung, Enne Hiu Ying
AU - Samuelson, Thomas W.
AU - Larsen, Christine L.
AU - Harvey, Alison
AU - Töteberg-Harms, Marc
AU - Meier-Gibbons, Frances
AU - Shu-Wen Chan, Nicole
AU - Sy, Jessica Belle
AU - Mansouri, Kaweh
AU - Zhang, Xiulan
AU - Lam, Dennis S.C.
N1 - Publisher Copyright:
© 2023 Asia-Pacific Academy of Ophthalmology. All rights reserved.
PY - 2023/11/27
Y1 - 2023/11/27
N2 - The development of minimally invasive glaucoma surgeries (MIGSs) was intended to provide safe and modestly efficacious modalities for early intervention of mild-to-moderate glaucoma, with minimal trauma and rapid recovery. They were mainly ab interno procedures that reduce intraocular pressure by facilitating the aqueous outflow by bypassing the trabecular meshwork resistance, reinforcing the uveoscleral flow via the supraciliary space, and reducing aqueous production by the ciliary body. While the cumulating evidence helps shape the role of the available MIGS, the exponential new development and advancement in this field has expanded the territory of MIGS. Apart from developing subconjunctival MIGS filtration devices (Xen gel stent and PRESERFLO MicroShunt), there is a tendency to revisit the "traditional" MIGS for alternative use and to modify the procedures with consideration of the fundamental aqueous outflow physiology. Combined MIGS has also been suggested, based on the theory that their different mechanisms may provide additive or synergistic effects. The advancement of laser procedures is also promising and could supplement unmet needs along the glaucoma treatment algorithm. This review examines the broad array of MIGS, updates the recent findings, discusses their potential alternative applications, and explores future challenges.
AB - The development of minimally invasive glaucoma surgeries (MIGSs) was intended to provide safe and modestly efficacious modalities for early intervention of mild-to-moderate glaucoma, with minimal trauma and rapid recovery. They were mainly ab interno procedures that reduce intraocular pressure by facilitating the aqueous outflow by bypassing the trabecular meshwork resistance, reinforcing the uveoscleral flow via the supraciliary space, and reducing aqueous production by the ciliary body. While the cumulating evidence helps shape the role of the available MIGS, the exponential new development and advancement in this field has expanded the territory of MIGS. Apart from developing subconjunctival MIGS filtration devices (Xen gel stent and PRESERFLO MicroShunt), there is a tendency to revisit the "traditional" MIGS for alternative use and to modify the procedures with consideration of the fundamental aqueous outflow physiology. Combined MIGS has also been suggested, based on the theory that their different mechanisms may provide additive or synergistic effects. The advancement of laser procedures is also promising and could supplement unmet needs along the glaucoma treatment algorithm. This review examines the broad array of MIGS, updates the recent findings, discusses their potential alternative applications, and explores future challenges.
KW - intraocular pressure
KW - minimally invasive glaucoma surgery
KW - subconjunctival
KW - suprachoroidal
KW - trabecular meshwork
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U2 - 10.1097/APO.0000000000000646
DO - 10.1097/APO.0000000000000646
M3 - Article
C2 - 38079242
AN - SCOPUS:85180531043
SN - 2162-0989
VL - 12
SP - 537
EP - 564
JO - Asia-Pacific Journal of Ophthalmology
JF - Asia-Pacific Journal of Ophthalmology
IS - 6
ER -