Usage Patterns of Minimally Invasive Glaucoma Surgery (MIGS) Differ by Glaucoma Type: IRIS Registry Analysis 2013–2018

ABSTRACT

Purpose

To examine patterns of standard (trabeculectomy or glaucoma drainage devices, GDDs) vs novel (minimally invasive glaucoma surgery, MIGS) surgical techniques in the US.

Methods

We used the American Academy of Ophthalmology (AAO) IRIS® Registry (Intelligent Research in Sight) queried between 2013 and 2018 (inclusive) to calculate the cumulative proportion of stand-alone, concurrent (same day) or sequential (subsequent day) glaucoma surgical techniques performed in each glaucoma diagnosis type. Secondary analyses of adjusted proportions of concurrent and sequential surgeries stratified by glaucoma diagnosis were also performed.

Results

Of 203,146 eyes receiving glaucoma surgeries, open angle glaucoma (OAG) was most likely to undergo all types of intervention. The iStent was the most commonly performed MIGS, primarily for those with normal tension glaucoma (NTG) or OAG (p < .001). Conversely, GDD was the most commonly performed procedure in secondary glaucoma or other (specified) glaucoma (p < .001). ECP and iStent were the most common concurrent procedures performed; most often for OAG and NTG (p < .001). After an initial standard surgery, most eyes underwent recurrent standard interventions (90.3%). ECP was the most common MIGS performed after an initial standard surgery; particularly in primary angle-closure (PACG) and secondary glaucoma eyes (p < .001).

Conclusion

Glaucoma type may influence the choice of glaucoma procedures and the decision to perform concurrent as well sequential surgical procedures. Given the poorly understood long term safety and effectiveness of MIGS, and with substantially increasing use of MIGS procedures in recent years, future studies comparing their safety and effectiveness vs standard interventions, for a variety of glaucoma types, is needed.

KEYWORDS:

• Minimally invasive glaucoma surgery
• iStent microstent
• Cypass
• Xen gel stent
• goniotomy
• canaloplasty
• endocyclophotocoagulation
• open angle glaucoma

Abbreviation/ Acronymns

MIGS (minimally invasive glaucoma surgery), ECP (Endocyclophotocoagulation), GATT (goniotomy-assisted transluminal trabeculotomy), GDD (glaucoma drainage device), IOP (intraocular pressure), TM (trabecular meshwork), OAG (open angle glaucoma), PACG (primary angle closure glaucoma), NTG (normal tension glaucoma), SD (standard deviation), CI (confidence intervals), ICD (International Statistical Classification of Diseases and Related Health Problems), CPT® (Current Procedural Terminology), IRIS® Registry (Intelligent Research in Sight)

Disclosure Statement

None of the authors have any proprietary interests or conflicts of interest related to this submission.

Review disclosures

Our manuscript has previously undergone peer review at Ophthalmology Glaucoma, but was not accepted for publication. We have attached our response to reviewers to our cover letter.