IRIS Registry compares MIGS, trabeculectomy and tubes

A new IRIS Registry analysis published in the American Journal of Ophthalmology on May 14 compared outcomes after minimally invasive glaucoma surgery, trabeculectomy and tube shunt surgery in young adults with secondary glaucoma. The study examined 2,483 eyes from patients aged 18 to 40 years who underwent one of the three procedures between 2013 and 2024 in the American Academy of Ophthalmology’s IRIS Registry. The paper focused on four secondary-glaucoma groups: traumatic glaucoma, uveitic glaucoma, steroid-induced glaucoma and glaucoma linked to other eye disorders. Ophthopedia separately posted a clinician-facing summary on May 14 pointing readers to the registry analysis, but the underlying findings come from the journal article and related conference reporting on the study. ### Which patients were included in the registry comparison? (ajo.com) The American Journal of Ophthalmology study included 2,483 eyes with secondary glaucoma in patients 18 to 40 years old. Those eyes underwent MIGS, trabeculectomy or tube shunt surgery and were identified in IRIS Registry data spanning 2013 through 2024. The IRIS Registry, or Intelligent Research in Sight, is the American Academy of Ophthalmology’s national clinical registry. (ajo.com) The Academy describes it as the nation’s first comprehensive eye-disease clinical registry. ### What outcomes did the researchers compare? The May 14 paper said it examined surgical outcomes across the three procedure types in young patients with secondary glaucoma. The study summary says the comparison covered postoperative intraocular pressure and surgery durability measures, including revision and reoperation outcomes. (ajo.com) Ophthalmology360’s report on the same research said investigators defined failure using four criteria: insufficient intraocular pressure reduction, hypotony, additional intraocular pressure-lowering surgery, or development of no light perception. (aao.org) David Friedman of Mass Eye and Ear and co-author Asahi Fujita discussed those results at the AGS 2026 Annual Meeting, according to the report. (ajo.com) ### Who led the analysis? Ophthalmology360 identified David Friedman, MD, PhD, MPH, and Asahi Fujita, MD, both of Mass Eye and Ear, as presenters discussing the registry study at the AGS 2026 Annual Meeting. Harvard Catalyst’s faculty profile for Fujita lists him as an author on recent IRIS Registry glaucoma analyses with Nazlee Zebardast and Friedman. (ophthalmology360.com) The authors used a large U.S. registry because outcomes for surgery in younger patients with secondary glaucoma have been less well characterized, Fujita said in the conference interview. That report said the researchers were evaluating whether less invasive surgery could be a workable option in some of these cases. (ophthalmology360.com) ### What specific findings have been reported so far? Ophthalmology360 reported that, in steroid-induced glaucoma, about two-thirds of eyes remained failure-free after trabeculectomy, while about 10% experienced hypotony. The same report said that in traumatic glaucoma, about half of eyes treated with MIGS remained failure-free at two years. (ophthalmology360.com) David Friedman said in the interview that the registry analysis found “decent pressure lowering” for at least a couple of years in some secondary glaucomas, including steroid-induced and traumatic cases. He also said trabeculectomy could reduce intraocular pressure effectively but carried a risk of hypotony in these patients. (ophthalmology360.com) ### How does this fit into the broader glaucoma surgery landscape? The American Academy of Ophthalmology’s EyeWiki says MIGS is generally positioned as a less invasive surgical option, while trabeculectomy and glaucoma drainage devices remain standard incisional procedures when pressure control is not achieved with drops or laser treatment. Separate review literature describes MIGS as aiming for a safer, conjunctiva-sparing approach than traditional filtering surgery. (ophthalmology360.com) The new registry analysis did not, in the material reviewed here, provide a single across-the-board winner among MIGS, trabeculectomy and tube shunts for all forms of secondary glaucoma. Instead, the published summary and conference discussion broke out outcomes by glaucoma subtype and by measures such as intraocular pressure control, hypotony and additional surgery. ### Where can clinicians find the full data next? (eyewiki.org) The full paper was published in the American Journal of Ophthalmology on May 14. The American Academy of Ophthalmology’s IRIS Registry page says researchers can also apply for opportunities to access IRIS Registry data through the Academy. (ajo.com)