The SKIBI study: Comparative early outcomes of five minimally invasive glaucoma surgeries combined with cataract extraction in Indian patients with primary open-angle glaucoma

PURPOSE: To evaluate and compare the early clinical outcomes of five microinvasive glaucoma surgery (MIGS) techniques-Suture-Gonioscopy-Assisted Transluminal Trabeculotomy (Suture-GATT), Kahook Dual Blade (KDB), iStent, Bent Ab Interno Needle Goniectomy (BANG), and iStent inject-combined with phacoemulsification, in a real-world cohort of Indian patients with primary open-angle glaucoma (POAG) and coexisting cataract. METHODS: This prospective observational study included 113 eyes of 113 patients undergoing MIGS with phacoemulsification at a tertiary care center. Patients were allocated to one of five MIGS groups in a nonrandomized fashion through shared decision-making based on clinical profile, affordability considerations, and device availability. The procedures included Suture-GATT (21 eyes), KDB (28 eyes), iStent (20 eyes), BANG (31 eyes), and iStent inject (13 eyes). The intraocular pressure (IOP) and antiglaucoma medication (AGM) use were recorded at baseline and at 1 week, 1 month, 3 months, and 6 months postoperatively. Safety and complications were also assessed. RESULTS: All procedures led to significant IOP and AGM reduction at 6 months (P < 0.05). Numerically greater mean IOP reduction was observed in the Suture-GATT group (6.41 ± 2.05 mmHg), with 71% achieving complete success. iStent inject and KDB also showed favorable outcomes. IStent-based procedures had the lowest complication rates. CONCLUSION: In real-world clinical practice, MIGS combined with cataract surgery offers a safe and effective option for IOP and medication reduction across a range of POAG severities. Procedure selection is influenced by patient-specific factors, including cost and device availability, underscoring the importance of individualized care in resource-variable settings.