Comparative efficacy and safety of microinvasive glaucoma surgeries in open angle glaucoma: a time-course network meta-analysis

Microinvasive glaucoma surgeries (MIGS) offer safer, less invasive alternatives, improving aqueous outflow with fewer complications than traditional surgeries. This network meta-analysis evaluated the efficacy of MIGS in reducing intraocular pressure (IOP) and postprocedural medication use. The relevant articles were searched up to July 2025 from PubMed, Scopus, and Web of Science. Two independent reviewers extracted data from the selected studies, including baseline information, outcomes, IOP, medication use, best-corrected visual acuity (BCVA), and cup-to-disc ratio (CDR). Total 357 records were collected after excluding 391 duplicates. Thorough screening resulted in the retrieval of 20 entries eligible for inclusion. iStent + phacoemulsification ranked highest (SUCRA 0.601) in IOP reduction, followed by Hydrus + phaco (SUCRA 0.521). The Hydrus microstent outperformed iStent at 12mo (MD -0.71, 95% CrI: -1.21:-0.22) and 18mo (MD -0.54, 95% CrI: -0.95:-0.14) in lowering the IOP. Phacoemulsification alone was inferior to iStent at all time points. Regarding the reduction of medication burden, iStent + phaco ranked best (SUCRA 0.584), yet the Hydrus microstent surpassed iStent at 24mo (MD -0.19, 95% CrI: -0.37:-0.02) in lowering medication use. Complications included stent malposition, hyphema, and transient IOP elevation across the two devices. Combining MIGS with phacoemulsification improved IOP control and reduces medication use more than phacoemulsification alone in open-angle glaucoma (OAG). The iStent ranked highest overall, while the Hydrus microstent showed better IOP reduction at certain timepoints.