Our Summary

This research paper explores the various complications that can occur following a type of eye surgery used to treat glaucoma, which is known as minimally invasive glaucoma surgery (MIGS) that doesn’t use a stent. The study analyzes reported complications from this surgery, including procedures such as gonioscopy-assisted transluminal trabeculotomy (GATT), bent needle goniectomy (BANG), Kahook-dual blade goniotomy, and microincisional trabeculectomy (MIT) done between 2014 and 2024.

The results show that, apart from common complications like blood in the front part of the eye, abnormal adhesion of the iris to the cornea, and spikes in eye pressure, there are other serious complications that can threaten vision. These include the separation of layers in the cornea, swelling of the cornea, dislocation of the iris, and loss or bleeding of the jelly-like substance in the eye. These complications can happen during or after the surgery.

The research concludes that, even though these surgeries are minimally invasive, all potential complications should be considered. Careful attention should be given during all stages of the surgery to prevent these complications from happening.

FAQs

  1. What are some possible complications after stent-less minimally invasive glaucoma surgery (MIGS)?
  2. What is the importance of adequate care during different stages of MIGS procedures?
  3. Can vision-threatening complications occur after incisional or excisional MIGS procedures?

Doctor’s Tip

A doctor might tell a patient undergoing glaucoma surgery to carefully follow post-operative instructions, including avoiding strenuous activities, refraining from rubbing or putting pressure on the eyes, and attending follow-up appointments. They may also recommend using prescribed eye drops as directed to help prevent complications and promote healing. It’s important to communicate any changes in vision or unusual symptoms to the doctor promptly to ensure optimal outcomes.

Suitable For

Glaucoma surgery is typically recommended for patients who have been diagnosed with glaucoma and have not responded well to other treatments such as medication or laser therapy. Patients with open-angle glaucoma, angle-closure glaucoma, or secondary glaucoma may be candidates for glaucoma surgery. Additionally, patients who are at risk of vision loss or have significant damage to the optic nerve may also be recommended for glaucoma surgery. It is important for patients to discuss their specific situation with their ophthalmologist to determine if they are a good candidate for glaucoma surgery.

Timeline

Before glaucoma surgery:

  1. Patient undergoes a comprehensive eye examination to determine the extent of their glaucoma and the most suitable treatment option.
  2. The patient and their ophthalmologist discuss the potential risks and benefits of the surgery.
  3. Pre-operative tests such as visual field testing, optical coherence tomography (OCT), and intraocular pressure measurement are conducted.
  4. The patient may be prescribed eye drops or other medications to prepare for surgery.

After glaucoma surgery:

  1. The patient may experience some discomfort, redness, and swelling in the eye immediately after surgery.
  2. The patient is typically advised to rest and avoid strenuous activities for a few days after the surgery.
  3. Follow-up appointments are scheduled to monitor the healing process and assess the effectiveness of the surgery.
  4. The patient may be prescribed eye drops or other medications to prevent infection and promote healing.
  5. Complications such as hyphema, peripheral anterior synechiae, and intraocular pressure spikes may occur postoperatively and require prompt management.
  6. Vision-threatening complications such as cyclodialysis, Descemet’s detachment, corneal edema, iridodilysis, vitreous loss, or vitreous hemorrhage can also occur and necessitate immediate intervention.
  7. The patient should adhere to the post-operative care instructions provided by their ophthalmologist to optimize the outcomes of the surgery.

What to Ask Your Doctor

  1. What are the potential complications associated with the specific type of glaucoma surgery being recommended?

  2. What steps will be taken during the surgery to minimize the risk of complications?

  3. How common are complications after this type of glaucoma surgery?

  4. What are the signs and symptoms of complications that I should watch for after the surgery?

  5. How will complications be managed if they occur?

  6. Are there any long-term risks or complications associated with this type of glaucoma surgery?

  7. Are there any specific factors about my eyes or overall health that may increase the risk of complications during or after the surgery?

  8. How experienced is the surgeon in performing this type of glaucoma surgery, and what is their success rate in avoiding complications?

  9. Are there any alternative treatment options that carry a lower risk of complications?

  10. How will follow-up care be provided after the surgery to monitor for any complications or address any concerns that may arise?

Reference

Authors: Rao A, Damagantla M, Krishnamurthy R, Senthil S. Journal: Semin Ophthalmol. 2025 Jul;40(5):382-388. doi: 10.1080/08820538.2025.2450687. Epub 2025 Jan 20. PMID: 39832945