A Systematic and Narrative Review of Safety and Complications in Minimally Invasive Glaucoma Surgery (MIGS) Between 2014–2024 [Letter]

Dear editor

We write to draw attention to a specific misclassification in Table 1 of the recent review by Gillmann et al, “A Systematic and Narrative Review of Safety and Complications in Minimally Invasive Glaucoma Surgery (MIGS) Between 2014–2024.”¹ While we acknowledge the authors’ commendable effort to synthesize safety data across a wide range of MIGS procedures, a material discrepancy between the manuscript body and Table 1 requires correction.

In the text, the authors accurately describe the findings from our first-in-human 24-month FLIGHT study,² noting that transient blood reflux into the anterior chamber was observed in 11 of 18 eyes (61.1%) on gonioscopy immediately after trabeculotomy creation, which resolved by postoperative day one and had no impact on vision.

Table 1, however, classifies this same event as “hyphema” with an incidence of 61.1%. This directly contradicts our original study, which explicitly reported zero cases of hyphema, as clearly documented in our Table 2 (Adverse Events).² The observed finding represents transient blood reflux: an expected physiological sign of Schlemm’s canal patency.

The clinical consequences of this misclassification are not trivial. The 61.1% figure in Table 1 is the highest hyphema rate reported across all 14 procedures in that table. Readers and clinicians comparing MIGS safety profiles across techniques, which is the purpose of this review, will reasonably interpret this figure as indicating an unusually high rate of postoperative hemorrhage, substantially distorting the perceived risk profile of FLIGHT.

We respectfully request that the journal correct this discrepancy and issue a formal erratum to:

• Remove “hyphema 61.1%” from the FLIGHT column of Table 1 and replace it with the accurate finding of transient blood reflux (11/18 eyes, 61.1%) with zero hyphema, consistent with the manuscript text;

• Ensure consistency between the tabulated data and the body of the manuscript; and

• Faithfully reflect the adverse event findings as reported in the primary study.

We appreciate the opportunity to bring this to your attention and trust that the correction will ensure this otherwise comprehensive review accurately represents the safety literature.

Disclosure

Dr Kinga Kranitz reports grants from Vialase Inc. (Scientific studies), outside the submitted work. Dr Iqbal Ahmed reports grants from Ne World Medical, Vision, Glaukos, Santen, Myra Vision, Elios Vision, Bionode, Abbvie, Royalties or licenses from Ocular Instrument, Oculus Surgical, Consulting fees from Zilia, Inc, Vizzario, Visus Therapeutics, Visci Ltd, Vialase, TFS Health Science, Thea Pharma, Tavo BioTherapeutics, Stroma, Spyglass Pharma, Smartlens, Inc, Sight Sciences, Shockwave Medical, Shifamed, Singapore Biodesign, Sierra Clinical Services, SeonixBio, Santen, Sanoculis, Ripple Therapeutics, Rheon Medical, Regeneron Pharmaceuticals, Radius XR, Radiance Therapeutics, Qlaris, PulseMedica, PolyActiva, Peripherex, Perfuse Therapeutics, Orbitau, Ophthalmic Therapeutics Innovation, Omega Ophthalmics, OcuSciences, Oculus Surgical, Ocular Therapeutics, Ocular Instrument, Noxelis, Nova Eye, New World Medical, Myra Vision, MST Surgical, Medicontur, Long Bridge Medical Inc, Liqid Medical, LayerBio, Johnson & Johnson Vision, iStar, iCare, Iridex, InjectSense, Implandata, Iantrek, Hexiris Pharma, Gore, Glaukos, Exhaura Limited, EyeX Solutions, EyeQ Technologies, EyeMed, Eye to Eye TeleHealth, eyeFlow, Inc, Emmes Biopharma Services, Elutimed, Elios Vision, Dragonfleye Therapeutics Corp, Custom Surgical, Corneat Vision, Ciliatech, Centricity Vision, Carl Zeiss, Bionode, Belkin Vision, Beaver Visitec, Bausch and Lomb, Balance Ophthalmics, Avisi, Avellino Lab USA, Inc, ArcScan, Aquea Health, Apellis Pharmaceutical, Amaros Engine, Aliph Medical, Alcon, Ace Vision, Abbvie, Honoraria for lectures from Glaukos, Abbvie, Johnson & Johnson, Bausch and Lomb, Alcon, Stock or stock options from Visci, Zilia Inc, Visus Therapeutics, Tavo Biotherapeutics, Stroma, Smartlens, Sannoculis, Retinalogik, Inc, RadiusXr, PulseMedica, Peripherex, Omega Ophthalmic, Long Bridge Medical, Lifelong Vision, LayerBio, InjectSense, Implandata, Hexiris, Exhaura Inc, Eye to Eye TeleHealth, EyeMed Technologies, EyeX Solutions, EyeQ Technologies, EyeFlow, Dragonfleye, Custom Surgical, Corneat, Centricity Vision, Bionod LLC, Belkin Vision, Avisi, Arcscan, Aquea Health, Amaros Inc, Aequus Pharmaceutical, Ace Vision, outside the submitted work. Dr Ticiana De Francesco is a consultant for Alcon, Abbvie, Elios, EyeD Pharma, Iantrek, Bausch and Lomb, Glaukos, Vialase, Nova Eye Medical, and Zeiss, outside the submitted work. Dr Tibor Juhasz is an employee and stockholder of ViaLase Inc., outside the submitted work. The authors report no other conflicts of interest in this communication.