MIGS in Severe Glaucoma: 12-Month Retrospective Efficacy and Safety of Microinvasive Glaucoma Surgery with Cataract Extraction

Figures & data

Table 1 Baseline Characteristics

Variable	Overall, N = 71	sMIGS, N = 37	cMIGS, N = 34	p-value
Demographic Characteristics
Age at surgery, mean (SD) [years]	72.46 (9.24)	73.32 (9.90)	71.52 (8.52)	0.49
Female sex, N (%)	34 (48%)	19 (51%)	15 (44%)	0.71
Race-Ethnicity, N (%)				0.39
White	37 (52%)	21 (57%)	16 (47%)
Black or African American	16 (23%)	8 (22%)	8 (24%)
Hispanic or Latino	6 (8.5%)	3 (8.1%)	3 (8.8%)
Asian	2 (2.8%)	1 (2.7%)	1 (2.9%)
Other	4 (5.6%)	0 (0.0%)	4 (12%)
Declined	6 (8.5%)	4 (11%)	2 (5.9%)
Non-English speaker, N (%)	15 (21%)	8 (22%)	7 (21%)	>0.99
Glaucoma Characteristics
IOP, mean (SD) [mmHg]	16.66 (5.81)	16.93 (6.32)	16.37 (5.27)	0.74
IOP ≤ 12 mmHg, N (%)	15 (21.1%)	7 (18.9%)	8 (23.5%)
IOP ≤ 17 mmHg, N (%)	49 (69.0%)	25 (67.6%)	24 (70.6%)
IOP ≤ goal IOP, N (%)	21 (29.6%)	12 (32.4%)	9 (26.5%)
Number of glaucoma medications, mean (SD)	2.28 (1.85)	1.68 (1.87)	2.94 (1.61)	0.002*
Glaucoma Type, N (%)				0.87
Primary Open Angle	47 (66%)	25 (68%)	22 (65%)
Mixed mechanism	12 (17%)	6 (16%)	6 (18%)
Pseudoexfoliation	6 (8.5%)	3 (8.1%)	3 (8.8%)
Pigmentary	1 (1.4%)	0 (0.0%)	1 (2.9%)
Normal or Low Tension	5 (7.0%)	3 (8.1%)	2 (5.9%)
Prior laser trabeculoplasty^a on operative eye, N (%)	17 (24%)	9 (24%)	8 (24%)	>0.99
Prior LPI on operative eye, N (%)	9 (13%)	5 (14%)	4 (12%)	>0.99
Other Ocular Characteristics
Best corrected distance VA LogMAR, mean (SD) [log unit]	0.41 (0.47)	0.41 (0.32)	0.41 (0.59)	0.14
Prior surgery on operative eye, N (%)				0.71
Non-Functioning Glaucoma Drainage Implant	3 (4.2%)	2 (5.4%)	1 (2.9%)
Scarred-Down Trabeculectomy	3 (4.2%)	1 (2.7%)	2 (5.9%)
Iridectomy	1 (1.4%)	0 (0.0%)	1 (2.9%)
Corneal	1 (1.4%)	1 (2.7%)	0 (0.0%)
Retinal	3 (4.2%)	2 (5.4%)	1 (2.9%)
None	60 (85%)	31 (84%)	29 (85%)
Procedure Characteristics
Procedure duration, mean (SD) [minutes]	40.61 (11.42)	41.16 (10.93)	40.00 (12.06)	0.56
Procedures with Kahook Dual Blade, N (%)	45 (63.4%)	13 (35.1%)	32 (94.1%)	—
Clock hours incised by KDB, mean (SD)	3.72 (0.66)	3.21 (0.76)	3.92 (0.51)	<0.001*
Procedures with Endocyclophotocoagulation, N (%)	49 (69%)	15 (40.5%)	34 (100%)	—
Degrees of ECP, mean (SD) [degrees]	210.33 (40.61)	227.14 (53.70)	202.97 (31.64)	0.12
Power of ECP, mean (SD) [W]	0.33 (0.07)	0.29 (0.09)	0.35 (0.06)	0.06
Procedures with Hydrus Microstent, N (%)	9 (12.7%)	9 (24.3%)	0 (0%)	—
Procedures with iStent infinite, N (%)	2 (2.8%)	0 (0%)	2 (5.9%)	—

Notes: Baseline demographics, disease characteristics, and procedural history in subjects who underwent phacoemulsification with single or combined MIGS (sMIGS or cMIGS respectively). Kruskal–Wallis rank sum tests and Pearson’s Chi-squared tests with significance defined as p < 0.05 (*). ^aLaser trabeculoplasty includes Laser Trabeculoplasty (LTP), Argon Laser Trabeculoplasty (ALT), or Selective Laser Trabeculoplasty (SLT).

Abbreviations: ECP, Endocyclophotocoagulation; IOP, Intraocular pressure; KDB, Kahook Dual Blade; LPI, Laser Peripheral Iridotomy; VA, visual acuity.

Table 2 Change in Intraocular Pressure

Outcome: IOP [mmHg]	Overall		sMIGS		cMIGS
	N	Mean (SD)	N	Mean (SD)	N	Mean (SD)
Baseline	71	16.7 (5.8)	37	16.9 (6.3)	34	16.4 (5.3)
6 weeks	67	13.0 (3.8)	35	13.2 (3.9)	32	12.8 (3.8)
3 months	46	12.4 (3.9)	24	13.0 (4.0)	22	11.8 (3.8)
6 months	51	13.5 (3.1)	30	14.1 (2.9)	21	12.6 (3.3)
12 months	37	13.5 (3.6)	19	14.1 (4.1)	18	12.8 (2.9)
P-values: Evaluating the pattern of change
Over time	<0.001*
Comparing sMIGS v cMIGS over time, unadjusted	0.07
Comparing sMIGS v cMIGS over time, adjusted^a	<0.05*

Notes: Mean intraocular pressure (IOP) at postoperative timepoints. Wald Tests were used to evaluate significant difference (p < 0.05) (*) between the pattern of change across timepoints, as well as comparatively between single MIGS (sMIGS) and combined MIGS (cMIGS). ^aAdjusted for baseline medications.

Table 3 Change in Medication Burden

Outcome: Medication Burden	Overall		sMIGS		cMIGS
	N	Mean (SD)	N	Mean (SD)	N	Mean (SD)
Baseline	71	2.3 (1.9)	37	1.7 (1.9)	34	2.9 (1.6)
6 weeks	67	1.6 (1.6)	35	1.3 (1.6)	32	1.9 (1.4)
3 months	46	1.5 (1.5)	24	1.2 (1.7)	22	1.8 (1.3)
6 months	51	1.6 (1.6)	30	1.2 (1.5)	21	2.1 (1.6)
12 months	37	1.8 (1.7)	19	1.3 (1.5)	18	2.4 (1.7)
P-values: Evaluating the pattern of change
Over time	0.03*
Comparing sMIGS v cMIGS over time, unadjusted	0.02*
Comparing sMIGS v cMIGS over time, adjusted^a	0.75

Notes: Medication number at postoperative timepoints. Wald Tests were used to evaluate significant difference (p < 0.05) (*) between the pattern of change across timepoints, as well as comparatively between single MIGS (sMIGS) and combined MIGS (cMIGS). ^aAdjusted for baseline medications.

Figure 1 Survival Curves.

Notes: Kaplan-Meier Survival Estimates with Log rank tests of significance (p < 0.05) for Survival Criteria (A) 12, (B) 17, and (C) goal.

Abbreviation: IOP, intraocular pressure.

Figure 2 Survival Curves Stratified by Single or Combined MIGS.

Notes: Kaplan-Meier Survival Estimates with Log rank tests of significance (p < 0.05) for different Survival Criteria (A) 12, (B) 17, and (C) goal.

Abbreviation: IOP, intraocular pressure.