New Developments in the Surgical Treatment of Glaucoma
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Purpose of Review
In this review, we aimed to provide, in a structured format, an evidenced based review of the current state of minimally invasive surgical glaucoma management.
Numerous studies, mostly non-comparative, have demonstrated several new, safe, effective, and minimally invasive surgeries for the management of various stages of open-angle glaucomas. These surgeries can either be combined with cataract surgery or performed in isolation of cataract surgery. Most of the newer minimally invasive procedures ensure safety with a mild to moderate intraocular pressure (IOP) lowering effect. Two novel shunts, the InnFocus MicroShunt and XEN45, however, can provide substantial IOP reduction in a relatively safe fashion.
The future of glaucoma surgery is very bright, and there continue to be several safe, effective, and novel procedures for the management of various types of glaucomas.
KeywordsGlaucoma surgery MIGS GATT Ab interno trabeculotomy IStent Kahook Dual Blade XEN45 InnFocus MicroShunt CyPass Endocyclophotocoagulation (ECP)
Compliance with Ethical Standards
Conflicts of Interest
Davinder S. Grover reports personal fees from Allergan, personal fees from Reichert Technologies, and personal fees from New World Medical, outside the submitted work.
Helen L. Kornmann and Ronald L. Fellman declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.• Grover DS, Godfrey DG, Smith O, Feuer WJ, Montes de Oca I, Fellman RL. Gonioscopy-assisted transluminal trabeculotomy, ab interno trabeculotomy: technique report and preliminary results. Ophthalmology. 2014;121(4):855–61. This study was the first study to describe the novel GATT procedure and report short-term outcomes. CrossRefPubMedGoogle Scholar
- 2.Grover DS, Godfrey DG, Smith O, et al. Outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with prior incisional glaucoma surgery. J Glaucoma. 2016;Google Scholar
- 3.Grover DS, Smith O, Fellman RL, Godfrey DG, Butler MR, Montes de Oca I, et al. Gonioscopy assisted transluminal trabeculotomy: an ab interno circumferential trabeculotomy for the treatment of primary congenital glaucoma and juvenile open angle glaucoma. Br J Ophthalmol. 2015 Feb 12;99:1092–6.Google Scholar
- 4.•• Fellman RL, Grover DS. Episcleral venous fluid wave: intraoperative evidence for patency of the conventional outflow system.” J Glaucoma. 2012. J Glaucoma. 2014;23(6):347–50. This study was the first study to describe the novel episcleral venous fluid wave and suggest that the presence and quality of the wave may predict outcomes following angle surgery. Google Scholar
- 5.Grover DS. American Academy of Ophthalmology Annual Meeting 2015 – Paper presentation. Gonioscopy-assisted transluminal Trabeculotomy (the GATT procedure): an ab interno circumferential trabeculotomy—mid term follow up November 17, 2015.Google Scholar
- 6.Grover DS, Flynn WJ, Bashford KP, Lewis RA, Duh YJ, Nangia RS, et al. Performance and safety of a new ab Interno gelatin stent in refractory Glaucoma at 12 months. Am J Ophthalmol. 2017 Aug 4;183:25–36.Google Scholar
- 7.Schlenker MB, Gulamhusein H, Conrad-Hengerer I, Somers A, Lenzhofer M, Stalmans I, et al. Efficacy, safety, and risk factors for failure of standalone ab interno gelatin microstent implantation versus standalone trabeculectomy. Ophthalmology. 2017 Nov;124(11):1579–88.Google Scholar
- 8.Batlle JF, Fantes F, Riss I, Pinchuk L, Alburquerque R, Kato YP, et al. Three-year follow-up of a novel aqueous humor microshunt. J Glaucoma. 2016;25(2):e58–65.Google Scholar
- 9.•• Craven ER, Katz LJ, Wells JM, Giamporcaro JE, iStent Study Group. Cataract surgery with trabecular micro-bypass stent implantation in patients with mild-to-moderate open-angle glaucoma and cataract: two-year follow-up. J Cataract Refract Surg. 2012;38:1339–45. This study was the first long-term prospective randomized controlled trial to demonstrate the safety of iStent but, more importantly, to demonstrate that cataract surgery alone has a significant impact on lowering IOP. CrossRefPubMedGoogle Scholar
- 10.Donnenfeld ED, Solomon KD, Voskanyan L, Chang DF, Samuelson TW, Ahmed II, et al. A prospective 3-year follow-up trial of implantation of two trabecular microbypass stents in open-angle glaucoma. Clin Ophthalmol. 2015;9:2057–65.Google Scholar
- 11.Katz LJ, Erb C, Carceller GA, Fea AM, Voskanyan L, Wells JM, et al. Prospective, randomized study of one, two, or three trabecular bypass stents in open-angle glaucoma subjects on topical hypotensive medication. Clin Ophthalmol. 2015;9:2313–20.Google Scholar
- 14.Greenwood MD, Seibold LK, Radcliffe NM, Dorairaj SK, Aref AA, Román JJ, et al. Goniotomy with a single-use dual blade: short-term results. J Cataract Refract Surg. 2017 Sep;43(9):1197–201.Google Scholar
- 17.García-Feijoo J, Rau M, Grisanti S, Grisanti S, Höh H, Erb C, et al. Supraciliary micro-stent implantation for open-angle glaucoma failing topical therapy: 1-year results of a multi-center study. Am J Ophthalmol. 2015;159:1075–81.Google Scholar
- 18.• Vold S, Ahmed II, Craven ER, et al. Two-year COMPASS results: supraciliary microstenting with phacoemulsification in patients with open-angle glaucoma and cataracts. Ophthalmology. 2016;10:2103–11. This study was the first study to describe the safety and efficacy of supra-choroidal shunt in a randomized controlled prospective clinical trial. CrossRefGoogle Scholar
- 22.Seigel MJ, Boling WS, Faridi OS, Gupta CK, Kim C, Boling RC, et al. Combined endoscopic cyclophotocoagulation and phacoemulsification versus phacoemulsification alone in the treatment of mild to moderate glaucoma. Clin Experiment Ophtalmolol. 2015;43:531–9.Google Scholar
- 25.Fellman RL. Lack of a visible outcome marker fuels the perfect storm of Dr Singh’s editorial. Ophthalmology. 2014;121(2):e12. https://doi.org/10.1016/j.ophtha.2013.09.029. Epub 2013 Dec 4