Combining Minimally Invasive Glaucoma Surgery With Cataract Surgery
MIGS comprises a diverse group of IOP-lowering procedures that have a better safety profile than do trabeculectomy and glaucoma drainage devices. Performing MIGS at the time of cataract extraction can benefit patients with mild to moderate glaucoma, especially those who cannot adhere to or tolerate IOP-lowering eyedrops. Even a modest pressure decrease following a combined MIGS/cataract surgery may lead to future dependency on fewer classes of eyedrops. This translates to improvement in quality of life.
Surgeons performing MIGS may utilize FDA-approved ab interno trabeculectomy devices, such as blades (eg, Trabectome [Kahook]), Schlemm canal implants (eg, iStent [Glaukos]), the Hydrus Microstent (Ivantis), and subconjunctival-space implants (eg, Xen Gel Stent [Allergan]).
Results of the HORIZON randomized multicenter clinical study showed significant IOP reduction and decreased medication use among patients with mild-to-moderate primary open angle glaucoma who received the Hydrus stent in combination with phacoemulsification, compared with patients who underwent phacoemulsification alone. Safety profiles were similar for the 2 arms. The iStent in combination with phacoemulsification also resulted in significant IOP reduction and decreased need for glaucoma medications versus phacoemulsification alone. The market withdrawal of the CyPass Micro-Stent (Alcon) because of increased endothelial cell loss in patients who received this device at time of cataract surgery emphasizes the importance of long-term clinical trials to evaluate the safety of relatively new devices.
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Excerpted from BCSC 2020-2021 series: Section 11 - Lens and Cataract. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.