Rowson Antonia C, Hogarty Daniel T, Maher Dominic, Liu Lei
Alfred Ophthalmology Unit, Alfred Health, Melbourne, VIC 3004, Australia.
Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, VIC 3002, Australia.
J Clin Med. 2022 Nov 18;11(22):6833. doi: 10.3390/jcm11226833.
Primary open-angle glaucoma progression in those already on maximal medical therapy has traditionally been treated with trabeculectomy, a surgical procedure that carries a high degree of morbidity. In the last few decades, significant advances have been made in the field of minimally invasive glaucoma surgery (MIGS) devices, which aim to defer or prevent trabeculectomy via less arduous surgical techniques in certain types of glaucoma. Although reviews have been published examining the efficacy of various MIGS techniques, no article synthesises the comparative safety of all available devices. We performed a literature review examining the safety of MIGS devices. Fifteen devices were included, variously attempting to increase aqueous outflow through the trabecular meshwork or the suprachoroidal space, shunting into the subconjunctival space, or reducing aqueous production through ciliary body ablation. Notably, the earliest product attempting to increase outflow to the suprachoroidal space, Alcon's CyPass Micro-Stent, was withdrawn from the market due to concerns regarding increased corneal endothelial cell loss at five years post-implantation. All other devices were described as well-tolerated, with the most common adverse effects including hyphaema, intraocular pressure spikes, and device migration or obstruction. MIGS devices are purported to be uniformly safe, and many studies report no statistically significant increased complications beyond those associated with cataract surgery alone. It is important to note, however, the generally poor quality of current studies, with a dearth of randomised, or even prospective, data, and a large proportion of studies funded by device producers.
对于那些已经接受最大程度药物治疗的原发性开角型青光眼患者,传统上采用小梁切除术进行治疗,该手术具有较高的发病率。在过去几十年中,微创青光眼手术(MIGS)设备领域取得了重大进展,其目的是通过在某些类型的青光眼中采用不那么艰巨的手术技术来推迟或避免小梁切除术。尽管已经发表了一些综述来研究各种MIGS技术的疗效,但没有文章综合所有可用设备的比较安全性。我们进行了一项文献综述,以研究MIGS设备的安全性。共纳入了15种设备,它们分别试图通过小梁网或脉络膜上腔增加房水流出、分流至结膜下间隙或通过睫状体消融减少房水生成。值得注意的是,最早试图增加脉络膜上腔流出的产品,爱尔康的CyPass微支架,由于担心植入后五年角膜内皮细胞损失增加而退出市场。所有其他设备都被描述为耐受性良好,最常见的不良反应包括前房积血、眼压峰值以及设备移位或阻塞。MIGS设备据称普遍安全,许多研究报告称,除了与白内障手术相关的并发症外,没有统计学上显著增加的并发症。然而,需要注意的是,目前研究的质量普遍较差,缺乏随机甚至前瞻性数据,而且很大一部分研究由设备生产商资助。