Page 118 - Read Online

Komzak et al. Mini-invasive Surg 2021;5:13 I http://dx.doi.org/10.20517/2574-1225.2020.103 Page 3 of 14

Table 1. Summary of current medical glaucoma treatment
Medication class Examples Mode of action Adverse effects Precautions
Prostaglandin Travoprost Increasing uveoscleral outflow of Iris hyperpigmentation Iritis/uveitis
analogues Bimatoprost aqueous humour Darkening/discolouration lid/ Herpetic keratitis
Latanoprost conjunctival oedema Aphakia
Tafluprost Uveitis or iritis Pregnancy
Unoprostone Macular oedema
b-adrenergic Timolol Suppress aqueous humour Blurred vision Systemic beta blockade
blockers Betaxolol production Stinging Asthma
Carteolol Bradycardia COPD
Metipranolol Bradyarrhythmia
Levubunolol
a-adrenergic Apraclonidine Suppress aqueous humour Ocular allergy Severe cardiovascular
agonists Brominidine production and increased Hyperaemia disease
uveoscleral outflow Ocular irritation
Dry mouth and nose
Taste disturbance
Headache
Carbonic anhydrase Brinzolamide Suppress aqueous humor Ocular irritation Compromised corneal
inhibitors Dorzolamide production Transient blurred vision endothelium
Acetazolamide Foreign body sensation Pregnancy
Bitter taste
Cholinergic agonists Pilocarpine Increased trabecular aqueous Blurred vision Uveitis
Carbachol humour outflow Myopia Iritis
Ocular irritation Risk of retinal detachment
Headache Heavily pigmented eyes
[1]
Summary of current glaucoma medications in descending order of treatment preference. COPD: Chronic obstructive pulmonary disease .

trabecular meshwork and Schlemm’s canal; (2) directing flow through the supraciliary space; (3) directing
aqueous outflow to the subconjunctival space; and (4) reducing the production of aqueous fluid at the
ciliary processes.

All of these methods share some common features including an ab-interno approach which spares incision
of the sclera, leading to a more favourable side effect profile compared with some other traditional pressure
lowering procedures such as trabeculectomy or ab-externo drainage devices. However, one important
distinction is that MIGS generally leads to a smaller reduction in intra-ocular pressure than more invasive
approaches, and for this reason it is important to consider the individual patient needs prior to deciding
upon the glaucoma management.

In this study a literature review was performed, assessing the different types of MIGS procedures and
providing an overview of their comparable efficacy in an effort to inform clinical decision making and
bring attention to the variety of MIGS available.

METHODS
A literature review was performed to identify studies that evaluated the efficacy and safety of various MIGS
procedures. For the purposes of this review, included studies had to provide data on currently available
forms of MIGS in terms of IOP and medication reductions, and also comment on the safety profile of these
devices. In the case of emerging MIGS, studies were included if they gave a description of these devices or
included a description of upcoming trials. Exclusion criteria included non-English language papers, non-
human research, case studies and articles written before the 1st of January 2015.

The electronic database used for this literature review was PubMed. The database was searched in October
2020. The search was limited to articles published from January 1, 2015 to October 9, 2020 in the English
language. The search terms were: [(MIGS OR micro invasive OR micro bypass OR stent) AND (glaucoma