# Complications of minimally invasive surgery for primary open-angle glaucoma in patients with diabetic retinopathy: a retrospective cohort study

## TL;DR

This study found that patients with diabetic retinopathy face higher risks of vision loss and eye bleeding after minimally invasive glaucoma surgery compared to those without the condition.

## Contribution

The study provides new evidence on MIGS complications specifically in patients with diabetic retinopathy and primary open-angle glaucoma.

## Key findings

- DR patients had a higher risk of vision loss (32.8% vs. 24.4%) after MIGS.
- Ocular hemorrhage was more common in DR patients (13.4% vs. 4.3%).
- Cataract formation rates were lower in DR patients at 3 and 6 months post-surgery.

## Abstract

Minimally invasive glaucoma surgery (MIGS) has become increasingly popular for treating primary open-angle glaucoma (POAG). However, data regarding complications for patients with comorbid diabetic retinopathy (DR) are limited. This study aimed to compare complications after MIGS in POAG patients with and without DR.

This is a retrospective cohort study using the TriNetX global health network. Adult patients with POAG who underwent MIGS were identified, with one group having comorbid DR and the other without. Propensity score matching was applied, yielding 518 patients per group for analysis. Complications assessed included vision loss, hypotony, ocular hypertension, cataract formation, eye infection, and any ocular hemorrhage. The primary outcomes were post-procedure complication rates and their statistical significance. Hazard ratios (HRs) with 95% confidence intervals (CIs) were computed.

Patients with DR who underwent MIGS had a higher risk for vision loss (32.8% vs. 24.4%, HR 1.443, 95% CI 1.13–1.841) and ocular hemorrhage (13.4% vs. 4.3%, HR 3.194, 95% CI 1.929–5.288) compared to those without DR. Cataract formation rates were lower in DR patients at 3 months (44.4% vs. 50.6%, p = 0.046) and 6 months (53.3% vs. 59.5%, p = 0.048) post-surgery. No significant differences were observed in rates of hypotony, ocular hypertension, or eye infection.

MIGS in patients with DR is associated with an increased risk of post-procedure complications, particularly vision loss and ocular hemorrhage. These findings can aid in the clinical management and counseling of patients with both POAG and DR considering MIGS.

The online version contains supplementary material available at 10.1007/s10792-026-03945-8.