Investigators reviewed 30-months worth of cases of reoperations that occurred within 90 days after minimally invasive glaucoma surgery (MIGS) at the Wills Eye Hospital in Philadelphia and found that the rate was low. When reoperations were necessary, elevated intraocular pressure (IOP) and complications associated with gel microstents were the top reasons.
While MIGS is a common treatment for patients with mild to moderate glaucoma, its effectiveness has been debated, according to researchers. The surgery is not without complications, which may include a decrease in vision, IOP spikes, device movement, hyphema, and corneal edema, and could require additional surgery.
Investigators reviewed the charts of adult patients who underwent trabecular microbypass stents, gel microstents, and goniotomy procedures (including gonioscopy-assisted transluminal trabeculotomy). Outcome measures were defined as unanticipated reoperations within the first 90 days after MIGS procedures and the complications that led to these reoperations.
As per the study, 448 MIGS procedures were performed on 436 eyes of 348 patients in the 30 month study period by 6 glaucoma surgeons. Of these, 206 (46.0 %) were trabecular microbypass stents, 152 (33.9%) were gel microstents, and 90 (20.1%) were goniotomy procedures. Combined phacoemulsification occurred in 256 eyes (58.7%). Reoperation within 90 days was necessary for 23 of 436 eyes (5.3%), including 16 of 152 eyes in the gel microstent group (10.5%), 4 of 198 eyes in the trabecular microbypass stent group (2.0%), and 3 of 90 eyes in the goniotomy group (3.3%). Reasons for reoperation were elevated IOP in 16 of 23 eyes (69.6%), gel microstent tip exposure with wound leakage in 3 of 23 eyes (13%), and early gel microstent encapsulation without elevated IOP in 1 of 23 eyes (4.3%). Additionally, 2 of 23 eyes (8.7%) required reoperation for lens complications while 1 of 23 eyes (4.3%) had elevated IOP and aphakia requiring reoperation.
Researchers note several limitations of their study, including that the need for reoperation was decided individually by each surgeon, not through a standardized protocol. Additionally, investigators focused on the 90 days post-surgery, which may be too short to capture delayed postoperative complications like late postoperative endophthalmitis.
Disclosure: Several study authors declared affiliations with the biotech and pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Shalaby WS, Bechay J, Myers JS, et al. Reoperation for complications within 90 days of minimally invasive glaucoma surgery, journal of cataract & refractive surgery. J Cataract Refract Surg. Published online, December 9, 2020. doi:10.1097/j.jcrs.0000000000000545