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Background <p>Glaucoma is a leading cause of irreversible blindness worldwide. Trabeculectomy remains a standard filtration procedure for substantial intraocular pressure (IOP) lowering but is associated with clinically relevant postoperative morbidity. Micro-invasive glaucoma procedures (MIGPs), encompassing minimally invasive glaucoma surgery (MIGS) and minimally invasive bleb-forming glaucoma surgery (MIBS), have been increasingly adopted to potentially improve safety while maintaining acceptable efficacy.</p> Objective <p>To&#xa0;compare the efficacy and safety of trabeculectomy versus MIGPs in glaucoma management.</p> Methods <p>PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science were searched from inception to 14 November 2025. Randomized controlled trials and observational comparative studies evaluating trabeculectomy versus MIGPs were eligible. The primary outcome was IOP reduction. Secondary outcomes included complete and qualified surgical success, postoperative medication burden, and adverse events including conjunctival hemorrhage and best-corrected visual acuity (BCVA) loss. Fixed- or random-effects models were applied according to heterogeneity. Risk of bias was assessed using RoB2 and ROBINS-I.</p> Results <p>Eighteen studies (2,476&#xa0;patients/eyes) were included.&#xa0;Compared with MIGPs, trabeculectomy achieved greater IOP reduction (mean difference −2.036 mmHg; p &lt; 0.0001).&#xa0;In contrast, MIGPs were associated with a lower postoperative medication burden (mean difference 0.188, expressed as trabeculectomy minus MIGPs; p &lt; 0.0001), indicating fewer medications postoperatively in the MIGPs group.&#xa0;MIGPs demonstrated higher odds of complete success (odds ratio 1.306, p = 0.016) but lower odds of qualified success (odds ratio 0.734, p = 0.031) relative to trabeculectomy. Safety outcomes favored MIGPs, with lower odds of conjunctival hemorrhage (logOR −0.79; approximately 55% lower odds) and lower odds of BCVA loss &gt;2 lines&#xa0;(logOR −0.75; approximately 53% lower odds).</p> Conclusion <p>Trabeculectomy provides greater IOP reduction, whereas MIGPs demonstrate a more favorable safety profile and reduced postoperative medication burden, with mixed effects on success definitions (higher complete success but lower qualified success). These findings support individualized surgical selection based on target IOP, risk tolerance, and patient-centered priorities.</p>

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Efficacy and safety of trabeculectomy versus micro-invasive glaucoma procedures (MIGPs) in managing glaucoma: a systematic review and meta-analysis

  • 期刊论文

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  • 发表日期：

    2026年2月13日

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  • Kai-Yang Chen,
  • Hoi-Chun Chan,
  • Chi-Ming Chan

摘要

Background

Glaucoma is a leading cause of irreversible blindness worldwide. Trabeculectomy remains a standard filtration procedure for substantial intraocular pressure (IOP) lowering but is associated with clinically relevant postoperative morbidity. Micro-invasive glaucoma procedures (MIGPs), encompassing minimally invasive glaucoma surgery (MIGS) and minimally invasive bleb-forming glaucoma surgery (MIBS), have been increasingly adopted to potentially improve safety while maintaining acceptable efficacy.

Objective

To compare the efficacy and safety of trabeculectomy versus MIGPs in glaucoma management.

Methods

PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science were searched from inception to 14 November 2025. Randomized controlled trials and observational comparative studies evaluating trabeculectomy versus MIGPs were eligible. The primary outcome was IOP reduction. Secondary outcomes included complete and qualified surgical success, postoperative medication burden, and adverse events including conjunctival hemorrhage and best-corrected visual acuity (BCVA) loss. Fixed- or random-effects models were applied according to heterogeneity. Risk of bias was assessed using RoB2 and ROBINS-I.

Results

Eighteen studies (2,476 patients/eyes) were included. Compared with MIGPs, trabeculectomy achieved greater IOP reduction (mean difference −2.036 mmHg; p < 0.0001). In contrast, MIGPs were associated with a lower postoperative medication burden (mean difference 0.188, expressed as trabeculectomy minus MIGPs; p < 0.0001), indicating fewer medications postoperatively in the MIGPs group. MIGPs demonstrated higher odds of complete success (odds ratio 1.306, p = 0.016) but lower odds of qualified success (odds ratio 0.734, p = 0.031) relative to trabeculectomy. Safety outcomes favored MIGPs, with lower odds of conjunctival hemorrhage (logOR −0.79; approximately 55% lower odds) and lower odds of BCVA loss >2 lines (logOR −0.75; approximately 53% lower odds).

Conclusion

Trabeculectomy provides greater IOP reduction, whereas MIGPs demonstrate a more favorable safety profile and reduced postoperative medication burden, with mixed effects on success definitions (higher complete success but lower qualified success). These findings support individualized surgical selection based on target IOP, risk tolerance, and patient-centered priorities.