MIGS Reduces Intraocular Pressure 20% to 50% in Angle-Closure Glaucoma

Primary angle-closure glaucoma remains a significant clinical challenge due to its high rate of irreversible vision loss and complex anatomical drivers, such as pupillary block and plateau iris configuration (a condition where the iris is pushed forward by the ciliary body, narrowing the drainage angle) [1, 2]. While phacotrabeculectomy (combined cataract extraction and traditional filtration surgery) is the conventional standard for advanced cases, it carries a 23.7% complication rate and requires intensive postoperative management [3, 4]. Minimally invasive glaucoma surgery has emerged as a safer alternative, with meta-analyses of 875 patients demonstrating a weighted mean intraocular pressure reduction of 7.71 mmHg (95% CI: 5.16 to 10.26) and a significant decrease in medication burden [5]. Specific techniques like phacogoniotomy have shown non-inferiority to phacotrabeculectomy in pressure reduction (26.1 mmHg versus 25.7 mmHg) while offering shorter operative times and improved quality of life scores [3]. Other approaches, including gonioscopy-assisted transluminal trabeculotomy (an ab interno procedure that opens the trabecular meshwork to restore physiological drainage), achieve a 76% success rate in angle-closure eyes, providing clinicians with mechanism-based options to refine surgical decision-making and tailor interventions to individual patient anatomy [6].