Angle-based Minimally Invasive Glaucoma Surgery-procedures in glaucoma treatment
Main Article Content
Abstract
Surgical procedures are playing an increasingly important role in the treatment of glaucoma. The mechanisms of increased intraocular pressure include structural alterations of tissue within the trabecular meshwork, in the chamber angle, Schlemm canal and the distal collector channels. These changes in the trabecular outflow pathway increase the resistance to the outflow of aqueous humor. Approximately 50-70% of the total outflow resistance in glaucomatous eyes occurs in the trabecular meshwork and 30-50% in Schlemm canal and the collector channels. Various minimally invasive glaucoma surgeries and/or microinvasive bleb-surgeries target these points. Compared to trabeculectomy, which is mainly used for advanced glaucoma and is associated with the use of cytostatics, the achievable pressure reduction is generally somewhat lower. However, the advantage of the newer, more individualized procedures is not only the significantly lower intra- and postoperative complication rate, but also the fact that they can already be used for mild to moderate glaucoma (70 % of all glaucoma patients). This enables efficient glaucoma treatment that can be started earlier, requires only a moderate reduction in pressure and is significantly more effective than glaucoma treatment with medication.
Keywords:
MIGS, Canaloplasty, ELT, Stents, Trabeculotomy, Suprachoroidale Drainage
Article Details
How to Cite
KLABE, Karsten; FRICKE, Andreas.
Angle-based Minimally Invasive Glaucoma Surgery-procedures in glaucoma treatment.
Medical Research Archives, [S.l.], v. 13, n. 7, july 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6761>. Date accessed: 06 dec. 2025.
doi: https://doi.org/10.18103/mra.v13i7.6761.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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5. Klabe K, Rüfer F. [Minimally invasive glaucoma surgery-Comparison of angle based procedures]. Ophthalmologie. 2023;120(4):358-371.
6. Hoffmann EM, Hengerer F, Klabe K, et al. [Glaucoma surgery today]. Ophthalmologe. 2021 Mar;118(3):239-247.
7. Deutsche Ophthalmologische Gesellschaft. Weißbuch zur ophthalmologischen Versorgungssituation in Deutschland. Munich, Germany: DOG; 2023.
8. Ziaei H, Au L. Manchester iStent study: long-term 7-year outcomes. Eye. 2021;35(8):2277–2282.
9. Lavia C, Dallorto L, Maule M, Ceccarelli M, Fea AM (2017) Minimally-invasive glaucoma surgeries (MIGS) for open angle glaucoma: a systematic review and meta-analysis. PLoS ONE. 2017;12(8):e183142.
10. Gillmann K, BravettiGE, Mermoud A, et al. A prospective analysis of iStent inject microstent positioning: Schlemmcanal dilatation and Intraocular pressure correlations. J Glaucoma. 2019;28(7):613–621.
11. Hengerer FH, Auffarth GU, Conrad-Hengerer I. 7-Year Efficacy and Safety of iStent inject Trabecular Micro-Bypass in Combined and Standalone Usage. Adv Ther. 2024;41(4):1481-1495.
12. Guedes RAP, Gravina DM, Lake JC, et al. Intermediate resultsof iStent or iStent inject implantation combined with cataract surgery in a real-world setting: a longitudinal retrospectivestudy. Ophthalmol Ther. 2019;8(1):87–100.
13. Manning D (2019) Real-world case series of iStent or iStent inject trabecular micro-bypass stents combined with cataract surgery. Ophthalmol Ther. 2019;8(4):549–561.
14. Shalaby WS,Lam SS, Arbabi A, et al. iStent versus iStent inject implantation combined with phacoemulsification in open angle glaucoma. Indian J Ophthalmol. 2021;69(9):2488–2495.
15. Sarkisian SR Jr, Grover DS, Gallardo M, et el. Effectiveness and Safety of iStent Infinite Trabecular Micro-Bypass for Uncontrolled Glaucoma. J Glaucoma. 2023;32(1):9–18.
16. Ahmed IIK, Berdahl JP, Yadgarov A. Six-Month Outcomes from a Prospective, Randomized Study of iStent infinite Versus Hydrus in Open-Angle Glaucoma: The INTEGRITY Study. Ophthalmol Ther. 2025;14 (5):1005-1024.
17. Vest Z, Alinaghizadeh N, Prendergast C. Third-Generation Trabecular Micro-Bypass Implantation with Phacoemulsification for Glaucoma. Ophthalmol Ther. 2025;14(3):529-539.
18. Siedlecki A, Kinariwala B, Sieminski S. Uveitis glaucoma-hyphema syndrome following iStent implantation. Case Rep Ophthalmol. 2022;13(1):82–88.
19. Rowson AC, Hogarty DT, Maher D. et al. Minimally invasive glaucoma surgery: safety of individual devices. J Clin Med. 2022;11(22):6833.
20. Ahmed IIK, De Francesco T, Rhee D, et al. Long-term outcomes from the HORIZON randomized trial for a Schlemm’s canal microstent in combination cataract and glaucoma surgery. Ophthalmology. 2022;129(7):742–751.
21. Montesano G, Ometto G, Ahmed IIK, et al. Five-Year Visual Field Outcomes of the HORIZON Trial. Am J Ophthalmol. 2023;251:143-155.
22. Holmes DP, Clement CI, Nguyen V, et al. Comparative study of 2-year outcomes for hydrus or iStent inject microinvasive glaucoma surgery implants with cataract surgery. Clin Exp Ophthalmol. 2022;50(3):303–311.
23. Komzak K, Allen PL, Toh T. Minimally invasive glaucoma surgery: comparison of Hydrus microstent with iStent inject in primary open-angle glaucoma. BMJ Open Ophthalmol. 2025;10(1):e001946.
24. Weich C, Zimmermann JA, Storp JJ, et al. Comparison of the Intraocular Pressure-Lowering Effect of Minimally Invasive Glaucoma Surgery (MIGS) iStent Inject W and Hydrus-The 12-Month Real-Life Data. Diagnostics (Basel). 2025;15(4):493.
25. Laroche D, Martin A, Brown A, et al. Mispositioned hydrus microstents: a case series imaged with NIDEK GS-1 gonioscope. J Ophthalmol. 2022; 2022:1605195.
26. Gallardo MJ, Supnet RA, Ahmed IIK. Circumferential viscodilation of Schlemm’s canal for open-angle glaucoma: ab-interno vs ab-externo canaloplasty with tensioning suture. Clin Ophthalmol. 2018;12:2493–2498.
27. Koerber N, Ondrejka S. 6-Year Efficacy and Safety of iTrack Ab-Interno Canaloplasty as a Stand-Alone Procedure and Combined With Cataract Surgery in Primary Open Angle and Pseudoexfoliative Glaucoma. J Glaucoma. 2024;33(3):176-182.
28. Hughes T, Traynor M. Clinical results of ab interno canaloplasty in patients with open angle glaucoma. Clin Ophthalmol. 2020;14:3641–3650.
29. Toneatto G, Zeppieri M, Papa V, et al. 360° Ab-Interno Schlemm's Canal Viscodilation with OMNI Viscosurgical Systems for Open-Angle Glaucoma-Midterm Results. J Clin Med. 2022;11(1):259.
30. Gallardo MJ. 24-month efficacy of viscodilation of Schlemm’s canal and the distal outflow system with itrack ab-interno canaloplasty for the treatment of primary open-angle glaucoma. Clin Ophthalmol. 2021;15:1591–1599.
31. Vold SD, Williamson BK, Hirsch L, et al. Canaloplasty and Trabeculotomy with the OMNI System in Pseudophakic Patients with Open-Angle Glaucoma: The ROMEO Study. Ophthalmol Glaucoma. 2021;4(2):173–81.
32. Klabe K, Kaymak H. Standalone Trabeculotomy and Viscodilation of Schlemm’s Canal and Collector Channels in Open-Angle Glaucoma Using the OMNI Surgical System: 24-Month Outcomes. Clin Ophthalmol. 2021;15:3121–9
33. Ondrejka S, Körber N, Dhamdhere K. Long-term effect of canaloplasty on intraocular pressure and use of intraocular pressure-lowering medications in patients with open-angle glaucoma. J Cataract Refract Surg. 2022;48(12):1388–93.
34. Grabska-Liberek I, Duda P, Rogowska M, et al. 12-month interim results of a prospective study of patients with mild to moderate open-angle glaucoma undergoing combined viscodilation of Schlemm’s canal and collector channels and 360° trabeculotomy as a standalone procedure or combined with cataract surgery. Eur J Ophthalmol. 2022;32(1):309–15.
35. Greenwood MD, Yadgarov A, Flowers BE, et al. 36-Month Outcomes from the Prospective GEMINI Study: Canaloplasty and Trabeculotomy Combined with Cataract Surgery for Patients with Primary Open-Angle Glaucoma. Clin Ophthalmol. 2023;17:3817-3824.
36. Radcliffe NM, Harris J, Garcia K, et al. Standalone Canaloplasty and Trabeculotomy Using the OMNI Surgical System in Eyes with Primary Open-Angle Glaucoma: A 36-Month Analysis from the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight). Am J Ophthalmol. 2025;271:436-444.
37. Al Yousef Y, Strzalkowska A, Hillenkamp J, et al. Comparison of a second-generation trabecular bypass (iStent inject) to ab interno trabeculectomy (trabectome) by exact matching. Graefes Arch Clin Exp Ophthalmol. 2020;258(12):2775–2780.
38. Kurji K, Rudnisky CJ, Rayat JS, et al. Phaco-trabectome versus phaco-iStent in patients with open angle glaucoma. Can J Ophthalmol. 2017;52 (1):99–106.
39. Pahlitzsch M, Davids AM, Winterhalter et al. Selective laser trabeculoplasty versusMIGS: forgotten art or firststep procedure in selected patients with openangle glaucoma. Ophthalmol Ther. 2021;10 (3):509–524.
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