Henein, C; Lee, R; Khaw, PT; (2018) New therapeutic avenues in glaucoma surgery. [Editorial comment]. Expert Review of Ophthalmology , 13 (5) pp. 253-255. 10.1080/17469899.2018.1513327.

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Abstract

Glaucoma filtration surgery (GFS) can be divided into penetrating and non-penetrating glaucoma surgery. Non-penetrating glaucoma surgeries (comprising deep sclerostomy and viscocanuloplasty) may have a more favorable risk profile in terms of hypotony-related complications and infections. However, due to its long learning curve and lower efficacy at reducing intraocular pressure (IOP), trabeculectomy remains the gold standard and the most commonly performed GFS. Aqueous shunts have traditionally been used in cases of refractory glaucoma following unsuccessful GFS surgery or in patients at high risk of GFS failure. Over the past decade, there has been marked increase in the development of new glaucoma drainage devices (GDDs). Emerging stents in the context of minimally invasive glaucoma surgery (MIGS) aim to improve the safety of glaucoma surgery without compromising efficacy and promote earlier surgical intervention. MIGS can have ab interno or ab externo approaches, some of which do not require a filtering bleb. Regardless of the type of filtration surgery or placement of devices draining into the subconjunctival or suprachoroidal space, scarring is the predominant cause of surgical failure. MIGS encompass a wide range of procedures utilizing endolasers, electrocautery devices, microcatheters, and stent implants with minimum or no scleral dissection. This editorial will focus on approved GDDs, stents, and anti-scarring therapies in glaucoma surgery.

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