Minimally Invasive Glaucoma Surgeries Can Improve Visual Field Outcomes

Minimally invasive glaucoma surgery (MIGS) combined with cataract surgery can effectively stabilize visual field function, as well as reduce intraocular pressure, lower the number of necessary glaucoma medications, and improve visual acuity, according to research published in Clinical Ophthalmology.

Researchers conducted a multicenter retrospective case series between 2013 and 2021 to determine the change in Humphrey visual field (VF) and clinical parameters after MIGS combined with cataract surgery. 

The study included patients who underwent MIGS combined with cataract surgery and had reliable preoperative and 12 to 18 month postoperative visual field measurements. 

The researchers compared clinical parameters between preoperative and postoperative visits, including best corrected visual acuity (BCVA), intraocular pressure (IOP), number of glaucoma medications, and visual field metrics (mean deviation [MD], pattern standard deviation [PSD], visual field index [VFI], and Collaborative Initial Glaucoma Treatment Study [CIGTS] score of total deviation probability and pattern deviation probability). They also compared outcomes across 3 different MIGS devices.

A total of 44 eyes from 39 patients (51.3% women and 48.7% men) were included in the study. Patients had a mean age of 72.4±7.2 years at the time of surgery. Most patients (68.2%) had primary open angle glaucoma.

The researchers found that BCVA improved from a mean of 0.23±0.17 at baseline to 0.10±0.14 logMAR during the follow up period (P <.001). They also observed a reduction in the number of glaucoma medications (mean±SD, 2.68±1.06 vs 1.46±1.32; P<.001) and decrease in IOP (mean±SD, 17.08±4.23 vs 14.92±3.13 mmHg; P=.003). They found no significant changes in VFI, MD, PSD, or CIGTS.

“As MIGS devices gain more popularity, it will be important to better characterize visual field changes after surgery,” according to the researchers. “In our cohort utilizing 3 different MIGS devices, the number of glaucoma medications decreased, the average IOP decreased, and the global and sector-based VF metrics largely remained stable.”

Limitations of the study included the retrospective design, potential selection bias, problems related to incomplete data and attrition, and the relatively short follow-up duration.