Les chirurgies trabéculaires dans la prise en charge du glaucome: une revue de la littérature

Trabecular MIGS (minimally invasive glaucoma surgery) procedures target the trabecular meshwork and Schlemm's canal in order to restore the physiological outflow of aqueous humor. Some approaches use implants, such as the iStent® or Hydrus®, which create a bypass to Schlemm's canal and thus improve drainage. Other techniques rely on incision or ablation of the trabecular meshwork, such as the Trabectome®, Kahook Dual Blade®, or gonioscopy-assisted transluminal trabeculotomy (GATT), to facilitate access to the collector channels. Devices like OMNI® or Visco360® combine canaloplasty and viscodilation to expand Schlemm's canal. Finally, excimer laser trabeculotomy offers a non-implant alternative by selectively perforating the trabecular meshwork. Clinical data show that these procedures, to varying degrees, lower intraocular pressure and reduce the need for topical medications, while presenting a safer profile than traditional filtering surgeries. The iStent® and Hydrus® benefit from the strongest scientific evidence, derived from phase III randomized trials that have confirmed their efficacy and safety. Ablative techniques are also effective but associated with a higher risk of hemorrhage, whereas ELT represents an interesting option free of implants. Overall, trabecular MIGS appears to be a safe and effective alternative for mild to moderate glaucoma, helping to reduce medication dependence and delay the need for more invasive surgeries, although outcomes vary depending on the technique and patient profile.