Rational selection between internal and external drainage approaches for microinvasive/minimally invasive glaucoma surgery in intraocular pressure control

Glaucoma stands as the leading cause of irreversible blindness, with primary open-angle glaucoma being the predominant type.Although its pathogenic mechanisms are intricate, lowering intraocular pressure remains the most effective treatment.Mainstream glaucoma surgeries aim to lower intraocular pressure by increasing aqueous humor outflow.Over the past two decades, microinvasive/minimally invasive glaucoma surgery (MIGS) has emerged as a hotspot in this field, focusing on minimizing incisions.Domestic practices have followed closely, but clinical outcomes have not been ideal.Based on a comprehensive understanding of the anatomy and pathophysiology of the aqueous outflow pathway and the design principles of various MIGS procedures, ophthalmologists should recognize the advantages and limitations of each technique.It is important to rationally choose between internal and external drainage MIGS and standardize their implementation.In the future, the use of non-invasive multimodal imaging techniques for preoperative assessment of the structural and functional aspects of the eye is expected to facilitate personalized selection and planning for precise treatment.

Glaucoma; Microinvasive/minimally invasive glaucoma surgery; Aqueous humor outflow; Internal drainage procedures; External drainage procedures