Long-Term Outcomes of Microinvasive Glaucoma Surgery (MIGS) vs.Trabeculectomy

Background: To compare the long-term efficacy and safety of Microinvasive Glaucoma Surgery (MIGS) and conventional trabeculectomy in patients with medically uncontrolled open-angle glaucoma. Methods: This prospective comparative study was conducted from January 2023 to January 2024 and included 72 eyes of 72 patients (36 MIGS, 36 trabeculectomy). All participants underwent baseline ocular evaluation and were followed for 36 months. Primary outcome was mean intraocular pressure (IOP) reduction. Secondary outcomes included percentage of patients achieving target IOP (<15 mmHg), reduction in glaucoma medications, and postoperative complications. Data were analyzed using t-tests, Chi-square, and Kaplan–Meier survival curves with significance set at p<0.05. Results: Both groups showed significant IOP reduction from baseline (p<0.001). Mean IOP reduction was greater in the trabeculectomy group (−9.8 ± 3.0 mmHg) compared to MIGS (−8.2 ± 2.7 mmHg, p=0.03). The proportion of patients achieving target IOP was higher with trabeculectomy (83.3% vs. 75.0%, p=0.39). Reduction in number of medications was comparable between groups (p=0.27). Complications such as hypotony and bleb leaks were significantly higher following trabeculectomy (p<0.05). Conclusion: Both MIGS and trabeculectomy are effective in long-term IOP reduction, but trabeculectomy provides greater pressure lowering at the cost of more complications. MIGS offers a safer alternative with meaningful IOP control and reduced medication burden, making it suitable for patients with mild-to-moderate glaucoma or those at higher surgical risk.