Review Article

Safety and Efficacy of Microinvasive Glaucoma Surgery

Table 3

Safety of MIGS devices.

AuthorYearPostoperative complications (n, %)Reoperations (n, %)

Sclemm’s canal devices
Trabectome
 Lee et al. [38]2016Herpetic keratitis reactivation = 1 (5.3)AC washout = 1 (5.3)
IOP > 21 mmHg = 5 (26.3)Repeat glaucoma surgery = 2 (10.5)

 Bussel et al. [37]2014Transient hypotony = 5 (6.8)Trabeculectomy = 4 (5.5)
Tube surgery = 6 (8.2)
Cyclophotocoagulation = 2 (2.7)
Repeat Trabectome = 1 (1.4)

 Jordan et al. [40]2013Reflux bleeding = 512 (91.9)AC lavage = 2 (0.4)
IOP > 30 mmHg = 44 (7.8)
Cystoid macular edema = 3 (0.5)

 Maeda et al. [64]2013Reflux bleeding = 80 (100)Repeat glaucoma surgery = 13 (16.3)
Reoperation (glaucoma surgery) = 13 (16.3)

 Ting et al. [36]2012Reflux bleeding = 692 (96.5)Repeat glaucoma surgery = 190 (23.0)
Early hypotony = 5 (0.6)

 Francis et al. [42]2008Transient hypotony = 4 (1.3)Trabeculectomy = 7 (2.3)
IOP > 10 mmHg from baseline = 32 (10.5)Tube surgery = 1 (0.3)
Reflux bleeding = 238 (78.3)
SLT = 1 (0.3)

 Minckler et al. [66]2005Reflux bleeding = 37 (100)0
Persistent minimal DM injury = 1 (2.7)
Peripheral anterior synaechiae = 9 (24.3)
Goniosynechiae = 5 (13.5)
IOP > 5 mmHg from baseline = 2 (5.4)

 Babighian et al. [49]2010IOP > 5 mmHg from baseline = 3 (20)0

 Wilmsmeyer et al. [48]2006Iris adhesion to corneal tunnel = 2 (1.5)Repeat glaucoma surgery = 25 (18.6)
Fibrin reaction = 3 (2.2)
CRVO = 1 (0.7)

iStent
 Tan and Au [23]2016Transient hyphema = 1 (2.4)0

 Neuhann [22]2015Stent not visible = 1 (1.6)Cyclophotocoagulation = 3 (4.8)
Posterior capsular opacification = 1 (1.6)Shunt surgery = 2 (3.2)

 Katz et al. [7]201500

 Vold et al. [15]2016Intraoperative stent malposition = 2 (3.7)0
Transient hyphema = 1 (1.9)
Intraoperative iridodialysis = 1 (1.9)

 Lindstrom et al. [16]201600

 Fea et al. [20]20150

 Donnenfeld et al. [10]2015Hyphema = 2 (5.1)AC paracentesis = 1 (2.6)

 Ahmed et al. [11]2014Transient hypotony = 1 (2.6)0
Progression of cataract = 4 (10.3)
Corneal ulcer = 1 (2.6)

 Arriola-Villalobos et al. [12]201300

 Craven et al. [17]2012Stent obstruction = 5 (4.3)Trabeculoplasty = 1 (0.9)
Stent malposition = 3 (2.6)Stent repositioning = 3 (2.6)
YAG laser for stent obstruction = 1 (0.9)Stent replacement = 1 (0.9)
Focal argon laser photocoagulation = 1 (0.9)

 Patel et al. [26]2013Hyphema = 1 (2.3)0
 Arriola-Villalobos et al. [25]201200

 Buchacra et al. [9]2011Stent malposition = 1 (10.0)0
Mild hyphema = 7 (70.0)
IOP ≥ 30 mmHg = 1 (10.0)
Corneal edema = 2 (20.0)
Stent obstruction by blood clot = 3 (30.0)

 Samuelson et al. [18]2011Stent obstruction = 4 (4.0)Stent repositioning = 3 (3.0)
Stent malposition = 3 (3.0)Stent replacement = 1 (1.0)
Elevated IOP = 2 (2.0)
Elevated IOP requiring treatment = 1 (1.0)
YAG laser for stent obstruction = 1 (1.0)

 Fernandez-Barrientos et al. [13]2010Stent malposition = 6 of 34 stents (17.6)0
Stent fall out = 1 of 34 stents (2.9)

 Spiegel et al. [27]2009Stent malposition (no repositioning) = 6 (10.3)Trabeculectomy = 2 (3.4)
Stent obstruction = 7 (12.1)Stent repositioning = 1 (1.7)
Argon laser = 1 (1.7)Stent replacement = 2 (3.4)
Corneal paracentesis = 1 (1.7)

 Vandewalle et al. [24]2009Stent malposition = 1 (10.0)0
Corneal erosion = 2 (20.0)
Blood reflux into angle = 5 (50.5)

 Voskanyan et al. [29]2014Elevated IOP requiring medications = 10 (10.1)Trabeculectomy = 1 (1.0)
YAG laser for stent obstruction = 2 (2.0)Phacotrabeculectomy = 1 (1.0)
Argon laser for stent obstruction = 1 (1.0)Goniotrephenation = 1 (1.0)
Stent obstruction = 3 (3.0)Deep sclerectomy = 1 (1.0)
Stent malposition = 1 (1.0)
Goniosynechiae (without treatment) = 1 (1.0)
Lens-iris synechiae (laser treatment) = 1 (1.0)
Stent not visible upon gonioscopy = 13 (13.1)

 Arriola-Villalobos et al. [30]201600

Hydrus
 Fea et al. [33]2016Transient IOP spike = 2 (6.5)0
BCVA < 2 lines from baseline = 3 (9.7)

 Gandolfi et al. [34]2016Transient hyphema = 4 (19.0)0
IO ≥ 30 mmHg within 48 hrs = 1 (4.8)
YAG lysis of PAS = 4 (19.0)

 Pfeiffer et al. [32]2015IOP > 10 mmHg from baseline = 2 (4.0)Repeat glaucoma surgery = 1 (2.1)
Focal PAS = 9 (18.8)

Suprachoroidal devices
CyPass
 Vold et al. [51]2016Corneal abrasion = 7 (1.9)Secondary ocular surgical intervention = 20 (5.5)
Corneal edema = 13 (3.5)
Cyclodialysis cleft > 2 mm circumference = 7 (1.9)
Iritis = 32 (8.6)
Hypotony = 11 (29.9)
IOP ≥ 10 mmHg above baseline = 16 (4.3)
Cystoid macular edema = 6 (1.3)
Stent obstruction = 8 (2.1)
Conjunctivitis = 4 (1.0)
Visual field loss progression = 25 (6.7)

 Garcia-Feijoo et al. [54]2015IOP > 30 mmHg = 7 (10.8)Trabeculectomy = 9 (13.8)
Transient hyphema = 4 (6.2)Additional CyPass = 2 (3.1)
BCVA reduced by ≥2 lines = 2 (3.1)
Laser trabeculoplasty = 1 (1.6)

 Hoeh et al. [53]2016Early postoperative IOP elevation = 2 (1.2)Repeat glaucoma surgery = 10 (6.0)
Late postoperative IOP elevation = 3 (1.8)Implant reposition = 1 (0.6)
Mild transient hyphema = 2 (1.2)Implant explantation = 1 (0.6)
Hypotony = 23 (13.8)
Endothelial touch = 2 (1.2)
Implant obstruction = 9 (5.4)
Macular edema = 1 (0.6)

 Hoeh et al. [52]2013AC reaction > 1 month = 8 (4.4)Device repositioning = 1 (0.6)
Early hypotony (<1 month) = 25 (13.8)Repeat glaucoma surgery = 9 (5.0)
Hypotony > 1 month = 1 (0.5)
Shallow AC without central touch = 1 (0.5)
IOP > 10 mmHg from baseline = 19 (10.5)
Postoperative hyphema = 2 (1.1)

Subconjunctival devices
XEN-45
 Perez-Torregrosa et al. [55]2016Encapsulation of filtration bleb = 1 (3.3)0

InnFocus
 Batlle et al. [63]2016Tube-iris touch = 3 (13.0)Repeat glaucoma surgery = 1 (4.3)
Transient hypotony < 3 months = 3 (13.0)AC paracentesis = 1 (4.3)
Shallow or flat AC = 3 (13.0)
Hyphema = 2 (8.7)
Choroidal effusion/detachment = 2 (8.7)
Elevated IOP requiring bleb needling = 1 (4.3)
Tube obstruction = 1 (4.3)
Vitreous hemorrhage = 1 (4.3)
Bleb leak = 1 (4.3)

AC: anterior chamber; BCVA: best corrected visual acuity; CRVO: central retinal vein occlusion; IOP: intraocular pressure; PAS: peripheral anterior synechiae; SLT: selective laser trabeculoplasty. Only prospective case series and randomized controlled trials are included.