Evaluating Long-Term Effectiveness and Safety of Glaucoma Surgical Innovations: A Systematic Review
- 1Centre of Public Health, Institute of Clinical Science, Queen’s University Belfast, Belfast, UK
- 2Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy
Abstract
Précis:: A systematic review examining the reporting of long-term safety of glaucoma surgical innovations. Twenty-seven studies met the inclusion criteria and demonstrated effectiveness over the short to medium term. Use of registries to optimise future long-term evaluation is recommended.
Purpose:: To synthesise evidence on the long-term effectiveness and safety of glaucoma surgical innovations introduced since 2004 and appraise reporting quality against IDEAL Stage 4 recommendations, designed to promote transparent study of the long-term impact of surgical innovations.
Methods:: MEDLINE, EMBASE, and CENTRAL were searched for studies published from January 1, 2014, to October 21, 2024. Eligible studies evaluated novel glaucoma surgery with ≥2 years’ follow-up and ≥100 participants. Randomised controlled trials, observational studies, registry analyses, and case series were included. Reporting was assessed using a 16-item adaptation of the IDEAL Stage 4 checklist. Risk of bias was assessed using Cochrane RoB 2, the Newcastle-Ottawa Scale, and the Joanna Briggs Institute case-series checklist.
Results:: The search strategy retrieved 1758 matches, with 27 studies meeting the inclusion criteria. Procedures included iStent, Xen-45 Gel stent, Hydrus microstent, Endoscopic photocoagulation, Trabectome and Kahook dual blade. Follow-up ranged from 2 to 6 years. All studies described design and 22 reported prespecified outcomes sufficiently; however, only 4 explained how missing data were handled. Intraocular-pressure and medication outcomes generally favoured the intervention, but heterogeneity in design, comparators, outcomes, and surgical context precluded pooled estimates. Adverse-event reporting was inconsistent. One cohort study was of poor quality; 14 case series had unclear or unreported methodological items; and 4 RCTs had at least one high-risk domain.
Conclusions:: Glaucoma surgical innovations appear effective over the medium term, but limited long-term follow-up and inconsistent safety reporting preclude firm conclusions about comparative effectiveness and long-term safety. Standardised reporting and prospective registries are needed.
Related
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- Evaluating the impact of social determinants of health on model performance and fairness in artificial intelligence for glaucoma progression prediction
- Extension of a Severed Paul Glaucoma Implant Tube Using the Crawford Lacrimal Tube: A Novel Surgical Technique.
- Real-world effectiveness and tolerability of fixed dose netarsudil/latanoprost in the management of patients with uncontrolled glaucoma
BibTeX
@article{ashok2026evaluating,
title = {{Evaluating Long-Term Effectiveness and Safety of Glaucoma Surgical Innovations: A Systematic Review}},
author = {Sanjana Ashok and Chiara De Vitto and Philip McCullough and Laura Luchetti and Anna Mengozzi and Augusto Azuara-Blanco},
journal = {Journal of Glaucoma},
year = {2026},
month = oct,
doi = {10.1097/ijg.0000000000002770},
url = {https://doi.org/10.1097/ijg.0000000000002770},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Evaluating Long-Term Effectiveness and Safety of Glaucoma Surgical Innovations: A Systematic Review
AU - Sanjana Ashok
AU - Chiara De Vitto
AU - Philip McCullough
AU - Laura Luchetti
AU - Anna Mengozzi
AU - Augusto Azuara-Blanco
PY - 2026
DA - 2026/10/16
JO - Journal of Glaucoma
DO - 10.1097/ijg.0000000000002770
UR - https://doi.org/10.1097/ijg.0000000000002770
AB - Précis:: A systematic review examining the reporting of long-term safety of glaucoma surgical innovations. Twenty-seven studies met the inclusion criteria and demonstrated effectiveness over the short to medium term. Use of registries to optimise future long-term evaluation is recommended. Purpose:: To synthesise evidence on the long-term effectiveness and safety of glaucoma surgical innovations introduced since 2004 and appraise reporting quality against IDEAL Stage 4 recommendations, designed to promote transparent study of the long-term impact of surgical innovations. Methods:: MEDLINE, EMBASE, and CENTRAL were searched for studies published from January 1, 2014, to October 21, 2024. Eligible studies evaluated novel glaucoma surgery with ≥2 years’ follow-up and ≥100 participants. Randomised controlled trials, observational studies, registry analyses, and case series were included. Reporting was assessed using a 16-item adaptation of the IDEAL Stage 4 checklist. Risk of bias was assessed using Cochrane RoB 2, the Newcastle-Ottawa Scale, and the Joanna Briggs Institute case-series checklist. Results:: The search strategy retrieved 1758 matches, with 27 studies meeting the inclusion criteria. Procedures included iStent, Xen-45 Gel stent, Hydrus microstent, Endoscopic photocoagulation, Trabectome and Kahook dual blade. Follow-up ranged from 2 to 6 years. All studies described design and 22 reported prespecified outcomes sufficiently; however, only 4 explained how missing data were handled. Intraocular-pressure and medication outcomes generally favoured the intervention, but heterogeneity in design, comparators, outcomes, and surgical context precluded pooled estimates. Adverse-event reporting was inconsistent. One cohort study was of poor quality; 14 case series had unclear or unreported methodological items; and 4 RCTs had at least one high-risk domain. Conclusions:: Glaucoma surgical innovations appear effective over the medium term, but limited long-term follow-up and inconsistent safety reporting preclude firm conclusions about comparative effectiveness and long-term safety. Standardised reporting and prospective registries are needed.
SN - 1057-0829
SN - 1536-481X
ER -