Trabecular Meshwork-Based MIGS: Efficacy, Technique Variability, and Wound Healing—A Comprehensive Review

<b>Background:</b> Glaucoma, a leading cause of blindness worldwide, can be managed surgically when medical treatments are insufficient. Trabecular meshwork (TM)-based micro-invasive glaucoma surgery (MIGS) has emerged as a less invasive surgical approach to lowering intraocular pressure (IOP) and managing glaucoma. <b>Methods:</b> This narrative review synthesizes the scientific literature and trials on TM-based MIGS techniques, including trabecular micro-bypass stents, goniotomy and trabeculotomy procedures, electrocautery and laser-based approaches, and ab interno canaloplasty. Among these techniques, efficacy, pivotal clinical trials, medication reduction, safety profiles, complications, and determinants of surgical success were examined. <b>Results:</b> While all TM-based MIGS devices assessed achieved meaningful IOP reduction compared with trabeculectomies, there was no consensus on which TM-based MIGS technique yielded the best outcomes. TM-based MIGS had a good safety profile compared with traditional glaucoma surgeries. Common postoperative complications included transient hyphema, corneal edema, and anterior chamber inflammation. Ultimately, the success of TM-based MIGS procedures depended on many factors, including surgical technique, device type, and patient-specific factors. <b>Conclusions:</b> TM-based MIGS are an effective and safe surgical management option for eligible glaucoma patients requiring moderate IOP reduction. Future research should focus on the long-term outcomes of MIGS procedures, compare MIS devices, and explore the mechanistic and histopathological changes induced by MIGS.