Nonimplant Glaucoma Surgery More Likely to Require Reoperation

Nonimplant glaucoma procedures are more likely to require follow-up reoperations than minimally invasive glaucoma surgeries (MIGS) that did include an implant, according to research presented at the American Society of Cataract and Refractive Surgery 2023 annual meeting, held in San Diego, CA, from May 5 to 8, 2023. Although the efficacy of the implant and nonimplant glaucoma procedures is comparable in terms of intraocular pressure (IOP) and medication reduction, more patients in the nonimplant group had uncontrolled IOP.

Natasha Kesav, MD, an ophthalmology resident at Case Western Reserve University/University Hospitals Cleveland Medical Center, was the presenting author of the research. Fellow authors were Stephen V. Lau, BM BCh, ABO, and Yasemin Sozeri, MD.

Researchers conducted a retrospective review of charts from January 2010 to February 2022 of patients with open angle glaucoma with moderate severity who underwent MIGS and cataract extraction. Moderate severity was defined as Humphrey visual field mean deviation between -6 dB and -12 dB.

They assessed best corrected visual acuity (BCVA) and visual field mean deviation (MD), rate of complications, and reoperations among patients with implants and those who underwent a nonimplant glaucoma procedure. They analyzed IOP and number of drug classes at postoperative day 1, postoperative week 1, and postoperative month 1, as well as at months 3, 6, 12, 18, and 24.

The patients in the implant MIGS group had greater IOP change from baseline on postoperative week 1 (mean -3.7 vs +0.5 mm Hg, P =.01) and postoperative month 1 (median -2.0 vs +1.5 mm Hg, P =.04) compared with the nonimplant glaucoma group (mean -3.7 vs. +0.5 mm Hg; P =.01, median -2.0 vs +1.5 mmHg P =.04, respectively). 

There were 6 reoperations in the nonimplant glaucoma group and 0 in the implant group (P =.03).

Limitations of the study also included its retrospective nature and relatively small sample size.