Purpose: The role of minimally invasive glaucoma surgery (MIGS) is unclear in the management of uveitic glaucoma, often felt to be contraindicated or insufficient. This retrospective study evaluates the long-term outcomes of MIGS in uveitic glaucoma.

Methods: This is a retrospective single center study examining MIGS surgical outcomes in 46 patients and 60 eyes with uveitic glaucoma. All eyes had a diagnosis of uveitis (any variant), which was adequately controlled at the time of MIGS. Types of MIGS examined included: canaloplasty with minimal goniotomy, trabecular meshwork bypass, or gel stent filter; all of which was performed by a single surgeon (SDA). The success of MIGS surgery was defined as final IOP between 6 and 21 mmHg, no glaucoma re-operation within 1 year (excluding bleb revisions), and either a decrease in IOP ≥20% or a decrease in IOP-lowering medications by ≥2 glaucoma drops at 3 months, 6 months, and 12 months post-operatively.

Results:

In 60 eyes with uveitis, 45% were quiescent off therapy, while the remainder required immunomodulatory therapy, intraocular steroid implants, or both. MIGS achieved overall success in ~77% of eyes at 12 months, with similar rates across uveitis subtypes and treatment regimens. XEN was the most commonly used procedure (73% success rate), though outcomes did not differ significantly by MIGS type. Mean IOP decreased from 21.5 ± 10.5 mmHg to 13.4 ± 5.3 mmHg at 12 months, with successful eyes maintaining IOP ~12–13 mmHg across all follow-up visits. Medication burden fell from 3.0 ± 1.3 to 0.8 ± 1.1 drops.

Conclusion:

This retrospective single center study examining MIGS outcomes in uveitic patients demonstrated that MIGS is an effective intervention at lowering IOP and reducing IOP lowering drop burden long term in uveitic patients.