DR Study Reports More Complications After MIGS

Controlling diabetic retinopathy as much as possible before a MIGS procedure may reduce the risk of postoperative complications. Photo: Steinkerchner MS, et al. Ophthalmol Sci. September 2025. Click image to enlarge. Minimally invasive glaucoma surgery (MIGS) is commonly employed for pressure reduction in open-angle glaucoma. However, outcomes data in eyes with diabetic retinopathy—a frequent comorbid condition among glaucoma patients—is limited. A recent International Ophthalmology paper revealed that glaucoma patients with diabetic retinopathy face an increased risk of certain postoperative complications that can worsen vision.Using the TriNetX global health network data, researchers obtained MIGS outcomes in adults with primary open-angle glaucoma with and without diabetic retinopathy. Two groups of 518 patients were analyzed.The researchers reported that those with diabetic retinopathy had a markedly higher likelihood of vision loss after undergoing MIGS than those without the disease (32.8% vs 24.4%). One potential cause may be the IOP reduction itself, which has been previously reported to cause retinal ischemia. The authors wrote that controlled pressure drops during surgery can mediate the risk of hypoperfusion.Eyes with diabetic retinopathy also had a higher risk of ocular hemorrhage (13.4% vs. 4.3%), which may have also contributed to vision loss in this cohort. The authors explained in their study that they weren’t surprised by this, since “postoperative hemorrhagic events in general occur in the majority of cases, depending on the specific procedure.” Notably, they didn’t include hyphema, which is common after MIGS, since they were unable to assess whether clot formation occurred.Additional findings included lower postoperative cataract formation rates at three and six months in the diabetic retinopathy group, potentially due to the condition’s underlying pathophysiology, which suppresses inflammation contributing to lens opacification. The researchers noted that their short follow-up window may have led to under-detection of cataract formation in diabetic retinopathy eyes. No significant differences were observed in the rates of hypotony, ocular hypertension or eye infection.The authors stated in their paper these postoperative outcomes are likely due to impaired retinal function and weakened vasculature caused by diabetic retinopathy, along with poor wound healing. Overall, they concluded that “MIGS appears to be a viable option for glaucoma management in patients with diabetic retinopathy, but it carries increased risks of vision loss and ocular hemorrhage in this population.” They recommended thorough preoperative counseling, potential modifications to surgical technique and more intensive postoperative monitoring.Click here for the journal source. Vaddavalli R, Madkour N, Jishu JA, et al. Complications of minimally invasive surgery for primary open-angle glaucoma patients with diabetic retinopathy: a retrospective cohort study. Int Ophthalmol 2026;46:103. [Epub February 5, 2026]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.