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Poitras V, Wells C, Hutnik C, et al. Optimal Use of Minimally Invasive Glaucoma Surgery: A Health Technology Assessment [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019 Jan. (CADTH Optimal Use Report, No. 8.1b.)
| Intervention | Comparator | Studies | Meta-Analysis Appropriate? |
|---|---|---|---|
| Research Questions 1 and 2 | |||
| MIGS Vs. Pharmacotherapy | |||
| 2x iStent | Travoprost (prostaglandin F analog) | Vold et al. 201658 | NO: Differences in the intervention (1st vs. 2nd generation iStent) and comparator (1 vs. 2 medications) |
| 2x iStent Inject | Combination Latanoprost/timolol (prostaglandin F analog and beta-blocker) | Fea et al. 201436 | |
| MIGS Vs. Laser Therapy | |||
| Hydrus Microstent | SLT | Fea et al. 201762 | NA |
| MIGS Vs. Another MIGS | |||
| iStent vs. 2x iStent vs. 3x iStent | See column 1 | Katz et al. 201859 and 201560 | NA |
| MIGS Vs. Filtration Surgery | |||
| ECP | Second GDD-2 (BGI) or AGI | Murakami et al. 201763 Lima et al. 200461 | NO: Different study designs, differences in patient populations (e.g., ~15 mm Hg difference in baseline IOP), differences in comparators (BGI or AGI) |
| Trabectome or 2x iStent Inject (combined [MIGS] or separate in analyses) | Trabeculectomy with MMC | Pahlitzsch et al. 201725 Jea et al. 201264 | NO: Different study designs (retrospective cohort, NRS), differences in patient populations (cohorts ~10 y difference in age; type of OAG NR in one study, and variety of types in the other; previous ocular procedures NR in one study and ~25% of sample in the other; more systemic hypertension in one sample; baseline IOP different by ~6 mm Hg) |
| XEN 45 microstent with MMC | Trabeculectomy with MMC | Schlenker et al. 201765 | NA |
| Research Questions 3 and 4 | |||
| MIGS + Cataract Surgery Vs. Cataract Surgery Alone | |||
| ECP + Phaco | Phaco alone | Kang et al. 201772 Perez Bartolome et al. 201773 Sheybani et al. 201574 Siegel et al. 201575 Francis et al. 201484 | NO: Different study designs (retrospective vs. prospective cohorts); different follow-up durations (ranging from 2 to 36 mo) |
| iStent + Phaco or 2x iStent + Phaco | Phaco alone | Fea et al. 201566 Fea 201067 Craven et al. 201268 Samuelson et al. 201134 El Wardani et al. 201576 Fernandez-Barrientos et al. 201069 | YES, subset: The two RCTs (Fea et al. 2015 and 2010; Craven et al. 2012 and Samuelson et al. 2011) were methodologically, statistically, and clinically suitable for pooling NO: El Wardani et al. was a different study design (retrospective cohort); Fernandez-Barrientos had a difference in intervention (2 iStents vs. 1 iStent) |
| CyPass Micro-Stent + Phacoa | Phaco alone | Vold et al. 201670 | NA |
| Hydrus Microstent | Phaco alone | Pfeiffer et al. 201571 Samuelson et al. 201888 | YES: These studies were methodologically, statistically, and clinically suitable for pooling |
| MIGS + Cataract Surgery Vs. A Different MIGS + Cataract Surgery | |||
| KDB + Phaco vs. iStent + Phaco | See column 1 | Dorairaj et al. 201886 | NA |
| Trabectome + Phaco vs. 2x iStent + Phaco | See column 1 | Kurji et al. 201779 Khan et al. 201578 | YES: These studies were methodologically, statistically, and clinically suitable for pooling |
| Trabectome + MICS vs. 2x iStent Inject + MICS | See column 1 | Gonnermann et al. 201777 | NA |
| iStent + Phaco vs. 2x iStent + Phaco vs. 3x iStent + Phaco | See column 1 | Vlasov and Kim 201780 Belovay et al. 201283 | NO: Different study designs (retrospective cohort vs. NRS), differences in intervention/comparison (different numbers of iStents) |
| ECP + iStent + Phaco | iStent + Phaco | Ferguson et al. 201781 | NA |
| ECP + Phaco vs. Trabectome + Phaco | See column 1 | Moghimi et al. 201889 | NA |
| MIGS + Cataract Surgery Vs. Invasive Surgery + Cataract Surgery | |||
| Trabectome + Phaco | Trabeculectomy with MMC + Phaco | Ting et al. 201887 | NA |
| Trabectome + Phaco | Trabeculotomy + Phaco | Kinoshita-Nakano et al. 201885 | NA |
| ECP + Phaco | Trabeculectomy with MMC + Phaco | Marco et al. 201782 | NA |
2x = two devices; 3x = three devices; AGI = Ahmed glaucoma implant; BGI = Baerveldt glaucoma implant 250 or 350; ECP = endoscopic cyclophotocoagulation; GDD = glaucoma drainage device; IOP = intraocular pressure; KDB = Kahook Dual Blade; MICS = micro-incision cataract surgery; MIGS = minimally invasive glaucoma surgery; MMC = mitomycin C; mo = months; NA = not applicable; NR = not reported; NRS = non-randomized intervention study; OAG = open-angle glaucoma; Phaco = phacoemulsification; RCT = randomized controlled trial; SLT = selective laser trabeculoplasty; vs. = versus; y = years.
The CyPass Micro-Stent was voluntarily withdrawn from the global market by the manufacturer in August 2018 due to five-year data from a long-term safety study;37,38 however, at the time of report publication, this device was still active in the Medical Devices Active Licence Listing and is therefore included in this report.
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Except where otherwise noted, this work is distributed under the terms of a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International licence (CC BY-NC-ND), a copy of which is available at http://creativecommons.org/licenses/by-nc-nd/4.0/
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