Clinical Debates in Minimally Invasive Glaucoma Surgery (MIGS)

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: 20 January 2025 | Viewed by 2409

Special Issue Editor


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Guest Editor
Sensho-kai Eye Institute, Uji, Kyoto 611-0043, Japan
Interests: glaucoma surgery; glaucoma imaging; minimally invasive glaucoma surgery (MIGS)

Special Issue Information

Dear Colleagues,

Glaucoma is one of the primary causes of blindness. Minimally invasive glaucoma surgeries (MIGSs), applied in cases of mild to moderate glaucoma, have gained increasing popularity in recent years because of their efficacy in reducing intraocular pressure, safety profile, simplicity of technique, and reduced risk of vision compromise. While various types of MIGS exist, differing in techniques, indication, outcome, and complications, these variations remain poorly elucidated. Moreover, the existing body of histopathological studies is insufficient for a comprehensive understanding of post-surgical wound healing. Consequently, debates persist among researchers regarding the mechanism by which MIGS reduces intraocular pressure, as well as differing opinions on whether the surgical technique impacts outcomes and the factors influencing surgical success. The history of MIGS is relatively short, lacking adequate systemic reviews or meta-analyses evaluating the influence of individual factors. Therefore, it is important to highlight disparities in researchers’ opinions at the current stage of research.

Dr. Etsuo Chihara
Guest Editor

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Keywords

  • MIGS (minimally invasive glaucoma surgery)
  • schlemm’s canal opening surgery
  • trabeculotomy
  • trabeculectomy
  • collector channel
  • histology
  • intraocular pressure
  • surgical success

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Published Papers (4 papers)

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Research

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11 pages, 647 KiB  
Article
Postoperative Outcomes of PreserFlo MicroShunt in Patients with Exfoliation Glaucoma
by Hiroyuki Wakuda, Ryota Aoki and Shunsuke Nakakura
J. Clin. Med. 2024, 13(20), 6132; https://doi.org/10.3390/jcm13206132 (registering DOI) - 15 Oct 2024
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Abstract
Objectives: This study aimed to evaluate the postoperative outcomes of the PreserFlo MicroShunt in Asian patients with exfoliation glaucoma. Methods: We used the Kaplan–Meier method to analyze 29 eyes of 29 patients with exfoliation glaucoma (mean age: 80.7 ± 8.3 years; [...] Read more.
Objectives: This study aimed to evaluate the postoperative outcomes of the PreserFlo MicroShunt in Asian patients with exfoliation glaucoma. Methods: We used the Kaplan–Meier method to analyze 29 eyes of 29 patients with exfoliation glaucoma (mean age: 80.7 ± 8.3 years; 16 males; 24 eyes with intraocular lens implants; preoperative intraocular pressure [IOP]: 32.5 ± 9.3 mmHg; preoperative antiglaucoma medications: 3.4 ± 1.0; Asian ethnicity: 100%) who underwent PreserFlo MicroShunt surgery alone at Saneikai Tsukazaki Hospital from November 2022 to November 2023. The criteria for survival were a reduction in IOP of ≥20%, no additional glaucoma surgery, and IOP of 5–21 mmHg (condition 1), 5–18 mmHg (condition 2), and 5–15 mmHg (condition 3). Needling and glaucoma eye drops were considered qualified successes. Results: The mean follow-up period was 27.9 weeks, with a reoperation rate of 31% (9 cases). The complete and qualified success survival rates at 24 weeks were 56%, 52%, and 49%, and 67%, 59%, and 53% for conditions 1–3, respectively. The complete and qualified success survival rates at 48 weeks were 47%, 43%, and 45%, and 52%, 46%, and 48% for conditions 1–3, respectively. Conclusions: The postoperative outcomes of the PreserFlo MicroShunt in Asian patients with exfoliation glaucoma demonstrated an approximate 50% success rate at both 24 and 48 weeks, with a reoperation rate of approximately 30%. Caution is warranted when performing PreserFlo MicroShunt in patients with exfoliation glaucoma. Full article
(This article belongs to the Special Issue Clinical Debates in Minimally Invasive Glaucoma Surgery (MIGS))
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12 pages, 1853 KiB  
Article
Visualization of the Postoperative Position of the Hydrus® Microstent Using Automatic 360° Gonioscopy
by Julian Alexander Zimmermann, Sarah Kleemann, Jens Julian Storp, Cedric Weich, Ralph-Laurent Merté, Nicole Eter and Viktoria Constanze Brücher
J. Clin. Med. 2024, 13(17), 5333; https://doi.org/10.3390/jcm13175333 - 9 Sep 2024
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Abstract
Introduction: Glaucoma, one leading cause of irreversible vision loss worldwide, is primarily caused by elevated intraocular pressure (IOP). Recently, minimally invasive glaucoma surgeries (MIGSs) have become popular due to their shorter surgical times, tissue-sparing nature, and faster recovery. One such MIGS, the [...] Read more.
Introduction: Glaucoma, one leading cause of irreversible vision loss worldwide, is primarily caused by elevated intraocular pressure (IOP). Recently, minimally invasive glaucoma surgeries (MIGSs) have become popular due to their shorter surgical times, tissue-sparing nature, and faster recovery. One such MIGS, the Hydrus® nickel–titanium alloy Microstent, helps lower IOP by improving aqueous humor outflow. The NIDEK GS-1 automated 360° gonioscope provides advanced imaging of the chamber angle for evaluation and documentation. The aim of this study was to test automated 360° gonioscopy for the detection of postoperative positional variations after Hydrus® Microstent implantation. This study is the largest to date to evaluate post-op positioning of the Hydrus® Microstent using the NIDEK GS-1. Materials and Methods: This study analyzed postoperative outcomes and stent location in eyes diagnosed with mild to moderate glaucoma that underwent Hydrus® Microstent implantation with or without phacoemulsification. Patients with prior IOP-lowering surgery or vitrectomy were excluded. Analyses of the postoperative Hydrus® Microstent position were based on the evaluation of automated 360° gonioscopy images. Results: Twenty-three eyes were included in the study, and all showed a reduction in IOP and a decrease in antiglaucomatous drop use postoperatively. Postoperative gonoscopic images showed variations in implant position. In all cases, the proximal inlet was clearly visible in the anterior chamber. The degree of protrusion into the anterior chamber was variable. The distal tip of the stent was visible behind the trabecular meshwork in Schlemm’s canal in five cases, in the anterior chamber in one case, and not visible in seven cases. In no case did postoperative alterations in the position of the implant lead to explantation. Conclusions: This study demonstrated that the Hydrus® Microstent can effectively lower IOP even in the presence of postoperative positional variations. Automated 360° gonioscopy was found to be a useful tool to verify and document the postoperative position of the implant. Positional changes did not require device explantation in any of the cases evaluated. Full article
(This article belongs to the Special Issue Clinical Debates in Minimally Invasive Glaucoma Surgery (MIGS))
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9 pages, 613 KiB  
Article
Comparing Corneal Biomechanic Changes between Solo Cataract Surgery and Microhook Ab Interno Trabeculotomy
by Ryo Asaoka, Shuichiro Aoki, Yuri Fujino, Shunsuke Nakakura, Hiroshi Murata and Yoshiaki Kiuchi
J. Clin. Med. 2024, 13(15), 4564; https://doi.org/10.3390/jcm13154564 - 5 Aug 2024
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Abstract
Background/Objectives: This study aimed to examine the postoperative changes in the corneal biomechanical properties between solo cataract surgery and solo microhook ab interno trabeculotomy (LOT). Methods: This retrospective case–control study included 37 eyes belonging to 26 patients who underwent solo cataract [...] Read more.
Background/Objectives: This study aimed to examine the postoperative changes in the corneal biomechanical properties between solo cataract surgery and solo microhook ab interno trabeculotomy (LOT). Methods: This retrospective case–control study included 37 eyes belonging to 26 patients who underwent solo cataract surgery and 37 eyes belonging to 31 patients who underwent solo µLOT. These two groups were matched according to their preoperative intraocular pressure (IOP), axial length (AL), and age. Corneal Visualization Scheimpflug Technology (Corvis ST) was used to obtain four biomechanical parameters representing the corneal stiffness or corneal deformation at the highest concavity, including stiffness parameter A1 (SP-A1), stress–strain index (SSI), peak distance (PD), and deflection amplitude max (DefAmpMax). These parameters were compared preoperatively and 6 months postoperatively, and between the two surgical groups. Results: Preoperatively, the patients’ IOP, age, and AL, as well as their results in four Corvis ST parameters, were similar between the two groups (p > 0.05). No significant difference was observed in SP-A1; however, PD and DefAmpMax were significantly larger, and SSI was significantly smaller postoperatively in the LOT group than in the cataract group. Conclusions: Corneal stiffness was reduced, and the cornea was more deformed with LOT than cataract surgery. Full article
(This article belongs to the Special Issue Clinical Debates in Minimally Invasive Glaucoma Surgery (MIGS))
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Review

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28 pages, 1580 KiB  
Review
Historical and Contemporary Debates in Schlemm’s Canal-Based MIGS
by Etsuo Chihara and Teruhiko Hamanaka
J. Clin. Med. 2024, 13(16), 4882; https://doi.org/10.3390/jcm13164882 - 19 Aug 2024
Viewed by 530
Abstract
Glaucoma is one of the primary causes of blindness worldwide. Canal opening surgery, a type of minimally invasive glaucoma surgery (MIGS) applied in cases of mild to moderate glaucoma, has gained increasing popularity in recent years due to its efficacy in reducing the [...] Read more.
Glaucoma is one of the primary causes of blindness worldwide. Canal opening surgery, a type of minimally invasive glaucoma surgery (MIGS) applied in cases of mild to moderate glaucoma, has gained increasing popularity in recent years due to its efficacy in reducing the intraocular pressure, its safety profile, the simplicity of its technique, and the reduced likelihood of compromised vision. Nevertheless, the existing body of histopathological studies remains insufficient for a comprehensive understanding of post-surgical wound healing. Consequently, debates persist among researchers regarding the mechanism through which Schlemm’s canal opening surgery reduces the intraocular pressure, as well as the surgical techniques that may impact the outcomes and the factors influencing surgical success. As the history of MIGS is relatively short and lacks sufficient systemic reviews or meta-analyses evaluating the influence of individual factors, this review was conducted to illuminate the disparities in researchers’ opinions at the current stage of research. Full article
(This article belongs to the Special Issue Clinical Debates in Minimally Invasive Glaucoma Surgery (MIGS))
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