The Efficacy and Safety of Minimally Invasive Glaucoma Surgery for Primary Open-Angle Glaucoma: A Systematic Review

Healthcare systems worldwide are burdened significantly due to glaucoma, which is a leading cause of irreversible blindness. A total of 76 million are currently affected, and it is estimated that by the year 2040, 112 million will be affected by glaucoma. Minimally invasive glaucoma surgery (MIGS) is a recent innovation that plays a key role in glaucoma management. We aimed to conduct a systematic review of the safety and efficacy of MIGS devices and procedures and their use in primary open-angle glaucoma (POAG) to lower intraocular pressure (IOP). Methods: A comprehensive electronic search of the PubMed database was conducted, and randomized controlled trials (RCTs) comparing MIGS devices and techniques with cataract surgery or other glaucoma procedures that had been published by 1 May 2025 were included. Results: Thirty RCTs were included in the systematic review. Studies show that MIGSs are as safe and effective as other procedures, including phacoemulsification and trabeculectomy, at lowering IOP. Conclusions: Short-term trials indicate that MIGSs are a safe and effective treatment option for primary open-angle glaucoma. MIGS procedures lead to favorable outcomes, including decreases in mean IOP and medication use, compared with other glaucoma procedures or standalone phacoemulsification. Independent long-term follow-up studies are needed further to elucidate the efficacy and long-term safety of MIGS.