Clinical Ophthalmology (Jul 2024)
MIGS in Severe Glaucoma: 12-Month Retrospective Efficacy and Safety of Microinvasive Glaucoma Surgery with Cataract Extraction
Abstract
Blake Oberfeld,1,2 Fatemeh Golsoorat Pahlaviani,1 Hani El Helwe,1 Henisk Falah,1 Nathan Hall,1 Jonathan Trzcinski,1 David Solá-Del Valle1,3,4 1Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA, USA; 2University of Florida, Department of Ophthalmology, Gainesville, FL, USA; 3Chittick Eye Care, Champaign, IL, USA; 4Carle Illinois College of Medicine, Urbana, IL, USACorrespondence: David Solá-Del Valle, Fax +16175733707, Email [email protected]: Despite holding promise, reports of using MIGS in severe glaucoma are scarce, and none has described combining multiple MIGS in this population. To the best of our knowledge, this is the largest study to report outcomes of phacoemulsification and MIGS (Phaco/MIGS) in patients with severe glaucoma.Methods: This retrospective review comprised 327 clinical visits of 71 patients with severe glaucoma who underwent Phaco/MIGS with iStent, endocyclodestruction, Kahook Dual Blade, Hydrus Microstent, or a combination of these MIGS (cMIGS) performed between 2016 and 2021. Primary outcomes included intraocular pressure (IOP) and medication burden evaluated by Generalized Estimating Equations, as well as Kaplan–Meier Estimates. Further analyses compared the efficacy of cMIGS and single Phaco/MIGS (sMIGS), procedure duration, visual acuity, and complications.Results: Mean preoperative IOP was 16.7 mmHg ± 5.8 (SD) on 2.3 ± 1.9 medications overall (N = 71), 16.9 ± 6.3 mmHg on 1.7 ± 1.9 medications in the sMIGS group (N = 37), and 16.4 ± 5.3 mmHg on 2.9 ± 1.6 medications in the cMIGS group (N = 34). Throughout 12 months, Phaco/MIGS led to significant reduction patterns in IOP (p < 0.001) and medications (p = 0.03). At 12 months, 47.5%, 87.5%, and 64.7% of the patients achieved IOP ≤ 12 mmHg, 17 mmHg, or predetermined goal IOP, respectively, without additional medication or procedure. Mean 12-month IOP was 13.5 ± 3.1 mmHg on 1.8 ± 1.7 medications. After adjusting for baseline medication burden, the reduction pattern in IOP (p < 0.05) was different between cMIGS and sMIGS, favoring cMIGS, and the groups had similar reduction patterns in medications (p = 0.75).Conclusion: The use of Phaco/MIGS in patients with cataract and severe glaucoma may significantly reduce IOP and medication burden throughout 12 months and, thus, may serve as a stepping stone in severe glaucoma patients with visually significant cataract before proceeding with more invasive glaucoma surgery. This effect may be potentiated by the combination effect of cMIGS.Plain Language Summary: Many patients with cataract and mild or moderate glaucoma who undergo cataract surgery also benefit from microinvasive glaucoma surgery (MIGS) performed at the same time, but the role of MIGS in patients with severe glaucoma and cataract is not clear. We report that combined cataract surgery and MIGS were associated with significant reductions in eye pressure in patients with severe glaucoma for more than 12 months.Keywords: microinvasive glaucoma surgery, MIGS, cMIGS, combined MIGS, generalized estimating equations, GEE, comparative effectiveness, combined efficacy, severe glaucoma
