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Glaucoma Surgery: Current Challenges and Future Perspectives
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Glaucoma Surgery: Current Challenges and Future Perspectives

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: 20 January 2026 | Viewed by 2196

Special Issue Editors

Prof. Dr. Tina Tzee Ling Wong

E-Mail Website
Guest Editor
Duke-NUS Medical School, Singapore, Singapore
Interests: glaucoma; MIGS; ophthalmic therapies; drug delivery
Prof. Dr. Esther M. Hoffmann

E-Mail Website
Guest Editor
Department of Ophthalmology, Universitätsmedizin Mainz, Mainz, Germany
Interests: glaucoma; adult and childhood glaucoma; MIGS; epidemiology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Glaucoma surgery faces several challenges that impact effectiveness and patient outcomes. The variability in surgical success rates is influenced by factors such as individual anatomy and pathophysiology. Post-operative scarring remains a very important obstacle for long-term surgical success of external filtration procedures.

Advances in biomaterials and targeted gene therapy seek to reduce scarring and improve performance of the surgical implants or trabeculectomy. Emerging imaging and AI may transform glaucoma management by enabling more personalized and predictable surgical outcomes. Advanced imaging techniques using optical coherence tomography provide detailed visualization of ocular structures, aiding precise surgical planning. It is anticipated that AI-driven models can identify patients at higher risk of complications and optimize timing and choice of surgery. Overall, integrating imaging and AI enhances accuracy, individualization, and prognosis in surgery, ultimately leading to better patient outcomes and more efficient, targeted treatments tailored to individual patients.

Future perspectives in glaucoma surgery aim to enhance safety, efficacy, and patient quality of life. This will include personalized surgical approaches based on genetic and biometric patient data, combined with advancements in imaging, biomaterials and regenerative medicine. Integrating technological innovations and personalized medicine may provide safer and more effective surgical options for glaucoma management in the future.

Prof. Dr. Tina Tzee Ling Wong
Prof. Dr. Esther M. Hoffmann
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • glaucoma
  • filtration surgery
  • trabeculectomy
  • MIGS
  • scarring
  • anti-metabolites
  • wound healing
  • anti-fibrotics

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Published Papers (3 papers)

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Research

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13 pages, 1130 KB  
Article
Primary PreserFlo MicroShunt Versus Trabeculectomy: Effectiveness and Safety in the Real World
by Anoushka N. Kothari and Graham A. Lee
J. Clin. Med. 2025, 14(21), 7484; https://doi.org/10.3390/jcm14217484 - 22 Oct 2025
Viewed by 800
Abstract
Backgrounds/Objectives: Trabeculectomy is the gold standard for glaucoma drainage surgery, but it is associated with a risk of sight-threatening complications. The PreserFlo MicroShunt (PF) is a less invasive alternative that aims to reduce complications and simplify post-operative care. This study aimed to compare [...] Read more.
Backgrounds/Objectives: Trabeculectomy is the gold standard for glaucoma drainage surgery, but it is associated with a risk of sight-threatening complications. The PreserFlo MicroShunt (PF) is a less invasive alternative that aims to reduce complications and simplify post-operative care. This study aimed to compare the effectiveness and safety of PF to trabeculectomy in the management of glaucoma. Methods: This was a retrospective cohort analysis of 95 eyes (48 PF, 47 trabeculectomy) from a single-center private practice in Brisbane, Australia. Data were collected from November 2017 to January 2024. Primary outcomes included intraocular pressure (IOP) and the number of medications. Secondary outcomes included best-corrected visual acuity (BCVA) and complications. Inverse probability of treatment weighting (IPTW) was applied to baseline covariates, and weighted regression and Cox proportional hazards models were then used to estimate treatment effects. Results: The two groups had comparable patient characteristics, although the PF group was older with worse visual field mean deviation. At 12 months, both procedures significantly reduced IOP and medications; however, differences were not statistically significant between groups (2.9 mmHg; 95%CI: −2.0, 7.9; p = 0.303, and 0.4; 95%CI: −0.13, 0.96; p = 0.138, respectively). The estimated probabilities of qualified success were comparable (74.9% PF vs. 72.5% trabeculectomy). Intra-operative stenting in PF eyes eliminated early post-operative hypotony. The incidence of open surgical revision in the PF group vs. the trabeculectomy group was 14.6% vs. 2.1% (p = 0.059, respectively). PF was associated with faster post-operative inflammation resolution (hazard ratio: 6.3; 95%CI: 2.8, 14.5; p < 0.001). Conclusions: Both PF and trabeculectomy are effective for glaucoma management. PF is a less invasive procedure with a lower rate of early hypotony when stented. Trabeculectomy has a tendency for lower IOP reduction and less requirement for open revision, although this did not reach statistical significance. This highlights the need for longer-term studies and improved techniques, such as more effective anti-fibrotic strategies. Full article
(This article belongs to the Special Issue Glaucoma Surgery: Current Challenges and Future Perspectives)
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13 pages, 1755 KB  
Article
Early Intrableb Features on Anterior Segment Swept-Source Optical Coherence Tomography Predict Surgical Success After Trabeculectomy in Uveitic and Neovascular Glaucoma
by Sangwoo Moon, Seungmin Lee and Jiwoong Lee
J. Clin. Med. 2025, 14(15), 5499; https://doi.org/10.3390/jcm14155499 - 5 Aug 2025
Viewed by 824
Abstract
Background: This study aimed to evaluate prognostic factors of early filtering blebs using anterior segment swept-source optical coherence tomography (AS SS-OCT) in patients with uveitic and neovascular glaucoma. Methods: This retrospective cohort study included 22 eyes from 22 patients who underwent [...] Read more.
Background: This study aimed to evaluate prognostic factors of early filtering blebs using anterior segment swept-source optical coherence tomography (AS SS-OCT) in patients with uveitic and neovascular glaucoma. Methods: This retrospective cohort study included 22 eyes from 22 patients who underwent trabeculectomy (11 eyes each with uveitic or neovascular glaucoma). Intrableb characteristics were assessed using AS SS-OCT at 1 month, postoperatively. Surgical success was defined as intraocular pressure (IOP) ≤ 18 mmHg and ≥30% IOP reduction without medication at 12 months. Logistic regression was used to identify the prognostic factors associated with IOP control. Results: Sixteen eyes (72.7%) achieved surgical success, while six (27.3%) were unsuccessful. Eyes with successful IOP control at 12 months showed thicker and less reflective bleb walls with microcysts compared with unsuccessful cases of IOP control, in the early postoperative phase (all p < 0.033). However, IOP at the time of OCT did not significantly differ between the groups (p = 0.083). Multivariate logistic regression analysis revealed that higher bleb wall reflectivity at 1-month post-trabeculectomy was significantly associated with a higher surgical failure rate at 12 months after trabeculectomy (hazard ratio = 1.072, p = 0.032). Conclusions: Early intrableb assessment using AS SS-OCT may be beneficial for managing filtering blebs after trabeculectomy in uveitic and neovascular glaucoma. Higher bleb wall reflectivity in the early post-trabeculectomy phase may indicate poor features of the filtering bleb, suggesting the need for timely interventions for refractory cases. Full article
(This article belongs to the Special Issue Glaucoma Surgery: Current Challenges and Future Perspectives)
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Review

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14 pages, 1310 KB  
Review
Current Challenges of Managing Fibrosis Post Glaucoma Surgery and Future Perspectives
by Phey Feng Lo, Seok Ting Lim, Xiaomeng Wang and Tina T. Wong
J. Clin. Med. 2025, 14(23), 8548; https://doi.org/10.3390/jcm14238548 - 2 Dec 2025
Viewed by 239
Abstract
The primary cause of post-operative failure following glaucoma filtration surgery is excessive bleb scarring. Traditional anti-fibrotics such as Mitomycin C (MMC) and 5-fluorouracil (5-FU) have greatly improved bleb survival but are not without their complications. Insights gained from traditional trabeculectomy studies can be [...] Read more.
The primary cause of post-operative failure following glaucoma filtration surgery is excessive bleb scarring. Traditional anti-fibrotics such as Mitomycin C (MMC) and 5-fluorouracil (5-FU) have greatly improved bleb survival but are not without their complications. Insights gained from traditional trabeculectomy studies can be directly applied to modern minimally invasive glaucoma surgery (MIGS) techniques. As surgical techniques continue to advance and overall safety improves, there is a growing need to explore other novel therapeutics that offer increased efficacy and favourable safety profiles. This review aims to provide insight into the pathophysiology of wound healing as well as discuss current and emerging strategies being developed to address wound healing post glaucoma filtration surgery. Full article
(This article belongs to the Special Issue Glaucoma Surgery: Current Challenges and Future Perspectives)
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