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Editors Selection IGR 24-3

Surgical Treatment: Does MIGS suppress diurnal IOP fluctuations?

Comment by Kaweh Mansouri on:

96373 Suppression of Diurnal (9AM-4PM) IOP Fluctuations with Minimally Invasive Glaucoma Surgery: An Analysis of Data from the Prospective, Multicenter, Single-Arm GEMINI Study, Pyfer MF; Gallardo M; Campbell A et al., Clinical Ophthalmology, 2021; 15: 3931-3938

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Pfyfer et al. evaluate the effect of the OMNI surgical system on reduction of daytime IOP fluctuations. This study has merit since it is one of few studies of MIGS looking at reduction of IOP fluctuations instead of a single IOP measurement.

They prospectively included 128 patients (almost all with POAG) from 15 ophthalmology practices in the US. Three IOP measurements (at 9AM, 12PM, 4PM) were performed at baseline and at year 1 after surgery. They authors found that not just absolute IOP but also IOP variability was significantly reduced after OMNI surgery, from an average of 2.8 mmHg (pre-op) to 1.8 mmHg (post-op).

Although this was a post-hoc analysis of the GEMINI study which was not conceived to study IOP fluctuations, its findings are nonetheless interesting in that they suggest that MIGS surgery may provide added benefit to IOP-lowering medications in terms of better diurnal IOP stability. However, before clinical conclusions can be drawn from these results at least 3 crucial questions remain to be answered: 1) are these findings reproducible?; 3) do they also apply to nocturnal IOP fluctuations?; and 3) do the reduced IOP fluctuations translate into reduced glaucoma progression?

In the meantime, the investigators are to be congratulated for their valuable work which should hopefully motivate others from evaluating IOP fluctuations after different MIGS techniques.

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