
==== Front
Heliyon
Heliyon
Heliyon
2405-8440
Elsevier

S2405-8440(24)12622-9
10.1016/j.heliyon.2024.e36591
e36591
Research Article
Global tendency and research trends of minimally invasive surgery for glaucoma from 1992 to 2023: A visual bibliometric analysis
Li Ruyue a
Liu Hanruo abc
Zhang Kaiwen a
Lu Zhecheng a
Wang Ningli wningli@vip.163.com
abcd⁎
a Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
b Beijing Institute of Ophthalmology, Beijing, 100730, China
c National Institute of Health Data Science at Peking University, Beijing, 100000, China
d Beijing Municipal Public Welfare Development and Reform Pilot Project for Medical Research Institutes (PWD&RPP-MRI, JYY2023-6), China
⁎ Corresponding author. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, China. wningli@vip.163.com
20 8 2024
30 8 2024
20 8 2024
10 16 e3659118 1 2024
14 8 2024
19 8 2024
© 2024 The Authors
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Background

Minimally invasive glaucoma surgery has become a popular research topic over the past decade. However, no published studies have provided a systematic overview for this field. A bibliometric analysis is urgently required to characterise current international trends and provide an intuitive description of past and emerging trends.

Methods

This study analysed minimally invasive glaucoma surgery-related studies by searching the Web of Science for relevant articles published between 1992 and 2023. All the retrieved titles and abstracts were screened for eligibility, and only articles and reviews written in English were included in the analysis. CiteSpace (version 6.1.6), VOSviewer (version 1.6.19), and the bibliometric package in RStudio were used to construct and visualise the results.

Results

A total of 1533 publications were included in the analysis with 26072 citations. A total of 4482 authors from 1191 organizations in 57 countries and regions published papers in 139 journals. After 2010, the number of publications increased significantly, with the highest annual productivity occurring in 2022 (n = 229, 15 %). Most of these studies were published in ophthalmology journals. The journal “Ophthalmology” ranked first with 30 papers and 5275 citations. Among the 10 most productive countries, the United States had the largest share of publications (n = 423, 36 %) and Switzerland had the highest proportion of multiple-country publications (70 %). Neodymium was the first keyword discovered, appearing in 1992 and continuing for 21 years. Kahook dual-blade, progression, gonioscopy-assisted transluminal trabeculotomy, efficacy, minimally invasive glaucoma surgery, cataract extraction, and primary open-angle glaucoma were the most recent keywords since 2020.

Conclusions

This was the first bibliometric analysis of minimally invasive glaucoma surgery and provides an overview of the developments in this field. Our results identified outstanding studies, countries, institutions, journals, and authors in the field to point the way forward for scientific research and clinical applications of minimally invasive glaucoma surgery.

Keywords

Minimally invasive glaucoma surgery
Bibliometric analysis
Glaucoma
Evolution
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pmc1 Introduction

Glaucoma is the most common, irreversible blindness-causing eye disease in the world. The number of patients with glaucoma is increasing annually, and the further growth of an aging population is increasing this disease burden. The global prevalence of glaucoma in people aged 40–80 years is 3.54 %, and the number of patients with glaucoma worldwide is expected to increase to 111.8 million by 2040 [1]. The clinical symptoms of glaucoma are insidious and most patients have experienced irreversible vision loss by the time of diagnosis. In addition, delayed or inadequate glaucoma treatment imposes a significant social and economic burden [2]. Therefore, the development and implementation of effective, accessible, and affordable treatment methods for patients with glaucoma have been identified as priority challenge in eye health care globally [3].

Surgery is the primary treatment option for glaucoma. Classic trabeculectomy (TRAB) was invented in 1968 and has been the gold standard procedure for glaucoma and has preserved the visual function of countless patients. However, it changes the physiological pathway of aqueous humour outflow and may lead to surgical failure due to postoperative low intraocular pressure (IOP), choroidal oedema, and bleb-related complications [4]. Since the beginning of the 21st century, minimally invasive glaucoma surgery (MIGS), which are more in line with physiological structures, have emerged and have shown great potential. MIGS refers to a diverse group of relatively new procedures that reduce IOP with limited or no disruption to conjunctiva or sclera. MIGS may lower IOP to a more modest degree than traditional filtering surgeries, but with less risk to patients. These innovative devices and procedures target different anatomical pathways to increase aqueous humour outflow and effectively reduce IOP. Based on the above principle, a series of MIGS devices and programs have been developed. At the same time, according to the different work paths, they can be divided into the following four categories: 1) increased aqueous outflow through trabecular meshwork and Schlemm's canal; 2) increased uveoscleral outflow through suprachoroidal space; 3) aqueous shunt through subconjunctival space; and 4) ciliary process ablation resulting in reduced aqueous outflow [5]. Currently, numerous MIGS-related studies have been published on surgical innovations, indications, mechanisms, and clinical outcomes. A study of trends in glaucoma surgery in China demonstrated a significant decline in TRAB, with MIGS undergoing a shift from external to internal drainage over the past 5 years [6]. However, due to the wide selection of MIGS, demographic factors, economic and social differences, access to healthcare, proficiency of ophthalmologists, and differences in the application of surgical aids, there is currently no unified standard or consensus for the classification, indication selection, perioperative management, and efficacy evaluation of MIGS worldwide.

Bibliometrics uses information related to publications (authors, journals, countries, institutions, and collaborative networks) to summarise the development and application trends in a field, enabling researchers to better understand the field and provide insights into future directions [7].

Although current studies have evaluated MIGS from different perspectives, a systematic overview of the field is lacking. Therefore, a comprehensive analysis is needed to understand research trends and provide insights for future directions in MIGS research. To bridge this substantial gap, we conducted a bibliometric analysis to characterise the current international trends and provide an overview of existing and emerging trends in MIGS from 1992 to 2023.

2 Methods

2.1 Data collection and search criteria

All publications related to MIGS were retrieved from the Web of Science (WOS) Core Collection database. We have compiled as complete a list of MIGS programs that fit the above definition as possible, with specific search strategies as follows: TS=(((Minimally Invasive Glaucoma Surger*) OR (Microinvasive glaucoma surger*) OR (micro-invasive glaucoma surger*) OR (Minimally Invasive Glaucoma Surgical Technique) OR (Micro incisional glaucoma surgery) OR (internal filtration surger*) OR (Ab interno trabeculotomy) OR (goniotomy) OR (Trabectome) OR (Kahook dual blade) OR (Goniotome) OR (iStent) OR (Trabecular Microbypass Stent) OR (Trabecular bypass device) OR (iStent Supra) OR (Hydrus) OR (intracanalicular scaffold) OR (Schlemm's Canal Scaffold) OR (gonioscopy assisted transluminal trabeculotomy) OR (Cypass) OR (Suprachoroidal Microstent) OR (Suprachoroidal shunt) OR (Xen) OR (Subconjuntival stent) OR (Innfocus) OR (PreserFlo) OR (Tanito Microhook ab interno trabeculotomy) OR (Microcatheter-assisted Trabeculotomy) OR (Goniosynechialysis) OR (Viscogonioplasty) OR (gonio-assessed angle plasty) OR (Ab interno canaloplasty) OR (Trabeculotome tunnelling trabeculoplasty) OR (canaloplasty) OR (ResGu CP) OR (penetrating canaloplasty) OR (Endoscopic cyclophotocoagulation) OR (Endocyclophotocoagulation) OR (micropulse transscleral laser treatment) OR (MicroPulse Cyclophotocoagulation) OR (Micropulse Transscleral Cyclophotocoagulation) OR (Ultrasound ciliary plasty) OR (High Intensity Focused Ultrasound) OR (Excimer laser trabeculostomy) OR (VISCO360) OR (high frequency deep sclerotomy) OR (TRAB360) OR (OMNI) OR (styrene-block-isobutylene-block-styrene)) AND (glaucoma)).

The inclusion and exclusion criteria were shown below (Fig. 1):1) The search period was from 1992 to October 27, 2023.

2) To ensure proper interpretation of the results, only peer-reviewed articles and reviews were included. 326 irrelevant papers were excluded (including comments, letters, and other types of publications).

3) The language of the publications was limited to English; 117 irrelevant papers were excluded.

4) Since we used a subject term search, as long as the keyword we set appeared in the title or abstract, the publication could be included. Furthermore, manual screening was conducted to exclude irrelevant studies. We read the title and abstract of each publication and excluded studies not associated with MIGS. In addition, MIGS was an abbreviation for other specialised terms, such as minimally invasive gynaecological surgery and miRNA-induced gene silencing. In total, 295 irrelevant papers were excluded.

5) The publication information of 1533 publications were downloaded in TXT format.

Fig. 1 The data collection and retrieval strategy.

Fig. 1

2.2 Data cleaning and statistical analysis

VOSviewer and CiteSpace are two commonly used analysis software in bibliometric analysis. VOSviewer (version 1.6.19) is a software program for the visual analysis of scientific literature, keywords, and author relationships. The core idea of this software is ‘co-occurrence clustering’, that is, 2 things appear at the same time, indicating that they are related. Subsequently, according to the intensity and direction of the relationship, different types of groups can be identified using clustering metrics. VOSviewer can be used for the multi-angle visual analysis of large-scale data and can provide 3 views according to user requirements: network visualisation, overlay visualisation, and density visualisation. CiteSpace (version 6.1.6) can visually capture hot topics, key scholars, and key research institutions in relevant research fields as well as show new research topics that have suddenly emerged within a specific time frame. CiteSpace can present 4 types of visual maps; the first type is for author, research institution, and country; the second type is for co-citation relationship between the cited reference and the cited author; the third type is for keywords and terms; and the fourth type is for research funds. The types of statistical tests used in this study are as follows:1) Bibliometric metrics: The Bibliometrix package in RStudio was employed for generating various bibliometric indicators, including annual publication counts, average citations per year, and productivity metrics for authors, institutions, and countries. These metrics are fundamental for assessing research output and impact. After uploading the TXT file obtained from WOS to the software, the software automatically obtains the above information. We further used GraphPad software (version 9.0) to convert the results into visual graphics.

2) Trend analysis: For examining trends in annual scientific publications and citations over time, we utilized descriptive statistical methods. These included identifying significant trends through visual inspection of time-series plots generated using GraphPad software. This approach is suitable for detecting and visualizing long-term trends in publication and citation counts.

3) Co-occurrence analysis: VOSviewer and CiteSpace automatically identify key information in TXT files, perform co-occurrence analysis, and explore the relationship between keywords, authors, and institutions. Specifically, VOSviewer is used to create web visualizations that reveal patterns of relationships and collaboration between authors, institutions, and countries. We show co-occurrence networks among authors who publish eight or more papers, institutions that publish ten or more papers, and the top 33 countries or regions with the most publications. CiteSpace provides visual maps based on keyword co-occurrence and co-citation relationships. Before further data mining and processing, all keywords identified by CiteSpace are cleared to obtain reasonable and accurate results [8]. The two authors carried out this operation separately and verified each other. Then we get the keyword co-occurrence network, the top 25 keywords and the co-cited network. This allows us to identify important terms and their relationships within the field of study, providing insights into emerging topics and research trends.

3 Results

3.1 Overall results of the publication search

Based on predefined search terms and periods, a total of 2271 publications published between 1992 and 2023 were retrieved from the WOS database. Applying the screening criteria detailed in the Methods part—such as language, research type, and research topic—1533 publications were ultimately included in the analysis (Fig. 1). These articles were published in 139 journals and authored by 4482 authors from 1191 organizations across 57 countries and territories.

3.2 Publication trends and analyses for the top 20 articles

As shown in Fig. 2, the total number of publications increased each year from 1992 to 2023. Before 2010, the number of publications related to MIGS was relatively small; however, after 2010, it increased significantly, with the largest annual productivity occurring in 2022 (n = 229, 15 %). Before 2010, surgical methods and devices were relatively basic, with technology still in the experimental phase and lacking long-term data. Since then, there have been significant advancements in both devices and techniques. Surgical approaches have become more diverse, including various combination procedures, and the accumulation of data on long-term outcomes and safety has progressively grown.Fig. 2 Trends of annual and total publications from 1992 to 2023.

Fig. 2

We also explored the citations for MIGS-related publications. A total of 1533 papers were cited 26072 times with an average of 17 citations per publication. The 20 most cited publications on MIGS are presented in Table 1, with a total of 3763 citations. These publications mainly focused on the clinical efficacy and safety evaluation of new MIGS procedures (n = 10, 50 %), as well as reviews and summaries of the current developments for MIGS (n = 10, 50 %).Table 1 The top 20 most cited publications.

Table 1Number	Author, year	Title	Journal	Topic	TC	TC per year	
1	SAHEB H, 2012	Micro-invasive glaucoma surgery: current perspectives and future directions [9]	CURR OPIN OPHTHALMOL	Review of MIGS development	363	30.25	
2	SAMUELSON TW, 2011	Randomized evaluation of the trabecular micro-bypass stent with phacoemulsification in patients with glaucoma and cataract [10]	OPHTHALMOLOGY	Safety and efficacy of a novel MIGS technology	350	26.92	
3	LAVIA C, 2017	Minimally-invasive glaucoma surgeries (MIGS) for open angle glaucoma: A systematic review and meta-analysis [11]	PLOS ONE	Review of MIGS development	241	34.43	
4	CRAVEN ER, 2012	Cataract surgery with trabecular micro-bypass stent implantation in patients with mild-to-moderate open-angle glaucoma and cataract: two-year follow-up [12]	J CATARACT REFR SURG	Safety and efficacy of a novel MIGS technology	229	19.08	
5	PINCHUK L, 2008,	Medical applications of poly (styrene-block-isobutylene-block-styrene) (“SIBS”) [13]	BIOMATERIALS	Review of a novel MIGS technology	218	13.63	
6	GROVER DS, 2014	Gonioscopy-assisted transluminal trabeculotomy, ab interno trabeculotomy: technique report and preliminary results [14]	OPHTHALMOLOGY	Technique report and preliminary results of a novel MIGS technology	194	19.40	
7	ARORA KS, 2015	Use of Various Glaucoma Surgeries and Procedures in Medicare Beneficiaries from 1994 to 2012 [15]	OPHTHALMOLOGY	Review of MIGS development	175	19.44	
8	MINCKLER DS, 2005	Clinical results with the Trabectome for treatment of open-angle glaucoma [16]	OPHTHALMOLOGY	Clinical results of a novel MIGS technology	172	9.05	
9	GROVER DS, 2017	Performance and Safety of a New Ab Interno Gelatin Stent in Refractory Glaucoma at 12 Months [17]	AM J OPHTHALMOL	Safety and efficacy of a novel MIGS technology	169	24.14	
10	CONLON R, 2017	Glaucoma treatment trends: a review [18]	CAN J OPHTHALMOL	Review of MIGS development	167	23.86	
11	RULLI E, 2013	Efficacy and safety of trabeculectomy vs nonpenetrating surgical procedures: a systematic review and meta-analysis [19]	JAMA OPHTHALMOL	Review of a novel MIGS technology	167	15.18	
12	AQUINO MCD, 2015	Micropulse versus continuous wave transscleral diode cyclophotocoagulation in refractory glaucoma: a randomized exploratory study [20]	CLIN EXP OPHTHALMOL	Safety and efficacy of a novel MIGS technology	161	17.89	
13	LEWIS RA, 2007	Canaloplasty: circumferential viscodilation and tensioning of Schlemm's canal using a flexible microcatheter for the treatment of open-angle glaucoma in adults: interim clinical study analysis [21]	J CATARACT REFR SURG	Safety and efficacy of a novel MIGS technology	156	9.18	
14	FRANCIS BA, 2011	Novel glaucoma procedures: a report by the American Academy of Ophthalmology [22]	OPHTHALMOLOGY	Review of MIGS development	155	11.92	
15	FEA AM, 2010	Phacoemulsification versus phacoemulsification with micro-bypass stent implantation in primary open-angle glaucoma: randomized double-masked clinical trial [23]	J CATARACT REFR SURG	Safety and efficacy of a novel MIGS technology	151	10.79	
16	LEWIS RA, 2014	Ab interno approach to the subconjunctival space using a collagen glaucoma stent [24]	J CATARACT REFR SURG	Review of a novel MIGS technology	146	14.60	
17	SAMUELSON TW, 2019	Prospective, Randomized, Controlled Pivotal Trial of an Ab Interno Implanted Trabecular Micro-Bypass in Primary Open-Angle Glaucoma and Cataract: Two-Year Results [25]	OPHTHALMOLOGY-a	Safety and efficacy of a novel MIGS technology	145	29.00	
18	TAN AM, 2010	Micropulse transscleral diode laser cyclophotocoagulation in the treatment of refractory glaucoma [26]	CLIN EXP OPHTHALMOL	Review of a novel MIGS technology	137	9.79	
19	CHEN J, 1997,	Endoscopic photocoagulation of the ciliary body for treatment of refractory glaucomas [27]	AM J OPHTHALMOL	Safety and efficacy of a novel MIGS technology	134	4.96	
20	VINOD K, 2017	Practice Preferences for Glaucoma Surgery: A Survey of the American Glaucoma Society [28]	J GLAUCOMA	Review of MIGS development	133	19.00	
Abbreviations: TC: total citations. MIGS: minimally invasive glaucoma surgery.

3.3 Analyses of the most productive journals and relationships between citings and cited journals

A total of 1533 papers were published in 139 journals. Table S1 lists the top 10 journals for citations of published papers. The journal “Ophthalmology” ranked first with 30 papers and 5275 citations. Most papers were published in ophthalmology journals.

The relationship between citings and cited journals is shown in Fig. S1. The left side shows the citing journals, the right side shows the cited journals, and the citation relationships are indicated by coloured lines from left to right. Articles published in neurology, sports, and ophthalmology journals mostly cited those published in ophthalmology, molecular biology, psychology, education, genetics, health, nursing, medicine, economics, and other journals.

3.4 Publication trends among countries or regions, and cooperation analyses

A total of 57 countries and regions contributed to publications in this field. Fig. 3 and Table S2 list the top 10 most productive countries according to the countries of the corresponding authors. The United States (n = 423; 36 %) had the largest share of publications, followed by Germany (n = 153; 13 %) and China (n = 137; 12 %). Switzerland had the highest proportion of multicountry publications (70 %), indicating a high rate of cooperation between Switzerland and other countries. France (3 %) and Spain (3 %) had the lowest proportions, which indicates less interactions with other countries. The cooperative relationships between the 33 countries or regions with the highest volume of publications are shown in Fig. 4a and b.Fig. 3 The top 10 most productive countries.

Abbreviations: MCP: multiple country publication.

Fig. 3

Fig. 4 The cooperation relationships between countries or regions.

Fig. 4

3.5 Publication trends of the top 10 authors and co-authorship analyses

The 1533 papers had 4482 authors, with an average of 2.92 authors per paper. Table 2 lists the 10 most productive authors concerning MIGS. The publications and total citations per year for these 10 authors from 2005 to 2023 are displayed in Fig. 5.Table 2 The top 10 most productive authors.

Table 2Rank	Authors	Number of articles	Citations, n	h-index	g-index	
1	AHMED IIK	32	694	17	32	
2	MANSOURI K	26	454	14	25	
3	KAHOOK MY	25	335	14	24	
4	LOEWEN NA	22	304	13	22	
5	SAMUELSON TW	22	841	18	22	
6	TANITO M	22	113	6	12	
7	MERMOUD A	20	356	13	20	
8	WANG NL	20	96	8	11	
9	FRANCIS BA	18	478	14	18	
10	SEIBOLD LK	18	287	11	18	

Fig. 5 The top 10 authors' annual production from 2004 to 2023.

Abbreviations: TC: total citations.

Fig. 5

We further selected authors with 8 or more publications to demonstrate the cooperative network among the 72 authors, which were divided into 6 clusters (Fig. 6a and b).Fig. 6 The cooperation relationships of authors or institutions.

(a-b) Cooperation relationships between authors. (c-d) Cooperation relationships between institutions. (a and c) Clusters between authors or institutions. (b and d) Time-related clusters.

Fig. 6

3.6 Publication trends among institutions and cooperation analyses

A total of 1191 institutions were included in the 1533 articles. The top 10 global institutions in the field of MIGS included the University College London, University of London, and University of California System, with 90, 83, and 80 papers, respectively (Table S3). The number of publications reflected the high level of research on MIGS in these institutions. Collaboration between institutions is a key driver of rapid development in the field of research, and we further analysed the partnership between different institutions. The cooperation analysis identified 61 institutions, each of which published at least 10 papers and produced 9 clusters (Fig. 6c and d).

3.7 Topics, co-occurrence network of ‘keywords’, and co-citation network

A total of 1386 keywords were used in 1533 articles and synonymous keywords were merged. Table S4 lists the top 20 most frequently used keywords in this study. Surgical procedures, IOP, surgical outcomes, safety, effectiveness, and other surgery-related keywords were the highest ranked.

CiteSpace was used to conduct a keyword burst analysis of the literature published from 1992 to 2023 and to extract the top 25 keywords with the strongest citation bursts (Fig. S2). Neodymium was the first keyword to be discovered, appearing in 1992 and continuing for 21 years. Viscocanalostomy was the most consistent keyword used. Kahook dual-blade, progression, gonioscopy-assisted transluminal trabeculotomy, efficacy, minimally invasive glaucoma surgery, cataract extraction, and primary open-angle glaucoma were the most recent keywords since 2020.

Co-occurrence and co-citation analyses were used to identify research hotspots in the MIGS field using visual networks. Node labels display keywords; the size of each node refers to the frequency of keyword occurrence, and the link connecting 2 nodes represents the co-occurrence relationship between 2 keywords (Fig. 7a and b). Reference co-citation analysis revealed 7 main clusters (Fig. 7c and d).Fig. 7 The co-occurrence and co-citation networks.

(a-b) Co-occurrence analyses of “Keywords”. (c-d) Co-citation analyses of publications. (a and c) Cluster-related networks. (b and d) Time-related networks.

Fig. 7

4 Discussion

MIGS is an important innovation in glaucoma treatment and offer new and wider options for patients with glaucoma. However, to date, no published study has summarised or reported the research and development trends for MIGS. This was the first systematic review of the field using a bibliometric analysis, and it attempts to define the direction for MIGS in the future.

Classic TRAB is the gold standard procedure for glaucoma treatment; however, its cumbersome postoperative process has inspired ophthalmologists to develop novel surgical methods [4]. The concept of MIGS was derived from minimally invasive surgery in the surgical field and is the latest addition to the surgical treatment paradigm for glaucoma (Fig. 8) [22]. Compared with traditional surgical methods, MIGS has the advantages of short operation time, smaller incisions, and fewer complications [29]. The peak in MIGS publications occurred after 2010 [30]. Since 2010, MIGS has shown rapid development in device innovation, surgical technology improvement, individualized treatment, and long-term effect studies. A variety of surgical devices were approved by the FDA during this time, such as iStent (2012), Kahook dual blade (2015), XEN Gel Stent (2016), iStent inject (2016), Cypass Micro-stent (2018), and Hydrus Microstent (2018) [31]. New MIGS procedures have also been developed, such as gonioscopy assisted transluminal trabeculotomy, which was first reported in 2011. It suggests that with the increasing number of patients with glaucoma, the need for a high quality of life, and the increase in MIGS procedure updates, MIGS will be an attractive study area in the future.Fig. 8 The development of minimally invasive glaucoma surgeries.

Fig. 8

Currently, there are a variety of parallel classification methods for MIGS, which can be divided into bleb-forming and non-bleb-forming surgeries according to whether the surgery forms blebs, aqueous humour drainage enhancement and aqueous humour formation reduction surgeries according to the mechanism of IOP reduction, and internal and external surgeries according to the surgical approach [32]. The 20 most highly cited articles were milestone studies in this field that focused on safety and efficacy evaluations of novel MIGS procedures and summarised current developments of MIGS. Most were published in high-impact ophthalmology journals, such as Ophthalmology, JAMA Ophthalmology, and American Journal of Ophthalmology. Researchers in this field may have more opportunities to obtain citations if they publish in high-impact journals.

MIGS is evolving and the efficacy and complications of each procedure should be considered independently. MIGS is typically assessed based on preoperative and postoperative IOP changes, medications, visual acuity, visual field, quality of life, reoperation rate, and the occurrence of postoperative short- and long-term complications [33]. According to published data, MIGS was less effective at reducing IOP than traditional glaucoma surgery, such as TRAB, although rarely resulted in severe complications; therefore, it has been considered to fill the treatment gap between medication, laser therapy, and traditional surgery for patients with mild-to-moderate glaucoma [34,35]. The World Glaucoma Association (WGA) guidelines recommend 3 years of follow-up after surgery and implants. However, the mean follow-up time for clinical efficacy and safety studies of MIGS was 19.9 ± 11.6 (range 6–48) months [36]. Based on the results of the 2-year COMPASS study, the FDA approved the CyPass Micro-Stent in 2016; however, based on 5-year follow-up data, it was voluntarily withdrawn from the market in August 2018 because of concerns about corneal endothelial damage after 5 years [33]. This suggests the need for high-quality, long-term, multicentre follow-up studies to identify the full range of potential adverse events associated with each MIGS procedure and device. At present, multicountry collaborations are dominated by developed countries. However, the burden of glaucoma-related blindness in developing countries is worrying [37]. This further limits MIGS development in developing countries. Therefore, conducting randomised controlled trials on MIGS worldwide is critical for reducing the burden of glaucoma.

In recent years, ‘precision medicine’ has become a new concept in personalised disease management. Although the rapid advances in MIGS have expanded the options available to glaucoma physicians, there is a clear need to better understand the anatomical and functional pathways. Exploring and understanding the action mechanisms of different surgical modalities could help accurately classify surgical modalities, guide personalised treatment, and improve surgical success.

The ‘trabecular meshwork pump’ theory has been a breakthrough in the anatomical structure, physiological function, and pathological characteristics of aqueous humour outlet channels [38]. Internal Schlemm's canal-related surgeries can convert external drainage into internal drainage, thus eliminate the complications related to external drainage surgery and reduce postoperative ocular surface complications, and are also suitable for patients who have repeated failures of traditional external filtration surgeries.

A study of trends in glaucoma surgery in China showed a significant decline in TRAB over the past 5 years, with MIGS procedures undergoing a shift from external to internal drainage [6]. Since the emergence of MIGS, the number of combined surgeries is increasing, and it is an effective option for patients with comorbid glaucoma and cataract. Goniotomy and canaloplasty were first used in the 1930s; however, their efficacy has not been fully demonstrated, and few studies have evaluated their efficacy in combination with phacoemulsification. Reoperation rates are lower in patients who underwent combined surgery (24 % vs. 6 %) than in those who underwent independent MIGS [35]. More recently, MIGS-related studies have focused on identifying new biomarkers by combining clinical phenotypes with genomics, proteomics, and metabolomics to stratify patients at risk of scarring [39]. High-frequency and emerging keywords can be regarded as indicating the hot topics and future development trends in related research.

Despite numerous clinical studies evaluating the efficacy and safety of MIGS, many have not adhered to standardized trial design and implementation procedures. Common issues include non-randomized study designs, variable reporting quality, unclear definitions and indications for MIGS, and missed important procedures, such as reporting patient-related outcomes and cost-effectiveness [40]. To address these issues, there is a need for a standardized framework and guidelines that clearly define the value, status, indications, and expectations of each MIGS procedure based on scientific, medical, and economic evidence [41]. The IDEAL framework, introduced in 2009, offers a structured approach for developing and evaluating surgical innovations, including MIGS. It aims to enhance safety, transparency, and effectiveness by providing clear guidance at each stage of development: Idea (initial idea and preliminary research), Development (early testing and refinement of the technology or device), Exploration (detailed clinical trials to assess feasibility, safety, and efficacy), Assessment (comparative effectiveness studies and long-term evaluations), and Long-term Follow-up (ongoing monitoring to ensure continued safety and efficacy). Implementing the IDEAL framework in MIGS research can standardize trial designs and improve reporting quality. We propose integrating this framework by developing standardized clinical trial protocols, defining clear outcome measures including patient-relevant outcomes and cost-effectiveness, and ensuring adherence to established guidelines. Additionally, adhering to the WGA guidelines—which cover recommended methodology, definition of success, ethical issues, postoperative complication reporting, economic evaluation, and statistical reporting—is crucial. Despite their importance, adherence to these guidelines is often inadequate, underscoring the need for stricter implementation [36]. Adopting these frameworks and methodologies will enhance consistency and reliability in MIGS research, ultimately improving the quality of evidence and patient care [40].

Due to the emergence and development of MIGS, there is an urgent need to clearly define the potential of these procedures in reducing IOP and to consider their role and position in the risk-benefit ratio. Health economics is increasingly used to comprehensively evaluate the effectiveness and economics of surgical procedures by measuring the cost-effectiveness of MIGS versus conventional treatments through statistical modelling and long-term comparison, which has guided policy formulation, medical insurance pricing, and selection of appropriate treatment [40]. The high initial cost of MIGS devices implies additional costs in addition to the usual costs of glaucoma surgery. However, high initial costs might be balanced by lower drug costs and slower disease progression after surgery. Health economics evaluations often compare the cost-effectiveness of MIGS to traditional anti-glaucoma treatments (TRAB, IOP-lowering drugs, or selective laser trabeculectomy); although studies from different countries and patient populations have drawn inconsistent conclusions [2,42,43]. The current cost-effectiveness analyses have several limitations. First, because of the different economic levels and surgical methods used in different countries and regions, the different study results may not be generalisable to other countries. Second, owing to the lack of long-term follow-up data on MIGS effectiveness, many assumptions regarding the long cycle of the Markov model are uncertain. Third, most health economics studies do not follow the same evaluation criteria, such as using different study perspectives and not considering the impact of indirect costs and long-term follow-up on outcomes, which limits their comparability to other study results. Therefore, future studies are urgently needed to raise the standards of MIGS economic analyses and conduct health technology assessments that combine evidence-based medicine and health economics to comprehensively evaluate technology characteristics, safety, effectiveness, economy, and social ethics to screen and promote new technologies with better cost-effectiveness.

In addition to economic factors, sociodemographic factors, access to healthcare, and the spread of electronic medical records are also key factors in assessing MIGS and their influence on its future development. Socioeconomic differences between countries, regions, and races lead to differences in healthcare environments, which affect the use of eye care. Due to a lack of infrastructure, unlike the promotion of population-based screening in developed countries, opportunistic screening in medical institutions is the mainstream practice in low- and middle-income countries (LMICs) [44]. In a community screening conducted in Nepal, up to 7.6 % of the participants were diagnosed with glaucoma [45]. In addition, most patients diagnosed with glaucoma in LMICs are usually at an advanced stage, with a higher proportion of patients from rural areas [46]. A study from Africa showed that rural patients with glaucoma have a higher rate of blindness than urban patients, which negatively affected their quality of life [47]. This further highlights the shortcomings of glaucoma treatment in developing countries. A published study noted that Medicare patients were more likely to undergo MIGS compared to privately insured patients (OR, 1.12, 95 % CI, 1.10–1.15); patients in LMICs, especially rural low-income patients, are unable to receive new surgical treatments such as MIGS in time due to the lack of basic medical insurance [48]. In addition to the key factors of healthcare disparities, it is important to obtain real-world data on sociodemographics, ophthalmic diagnoses, surgical procedures, prescription drugs, and other relevant patient characteristics from electronic health records to gain insights regarding practice patterns that may help evaluate the long-term performance of MIGS in different patient populations.

5 Limitations

This study was the first to use a bibliometric analysis to systematically review MIGS and clarify its future development directions. However, this study has certain limitations. First, there is currently a lack of a clear MIGS definition in different countries and regions, which has led to disputes over content for inclusion. We comprehensively refined the MIGS definition using international guidelines. High-quality international multicentre studies are needed to clarify the definition and classification of MIGS and to guide future studies. This study provides a reference for the standardisation of this field., The high-impact scholars, institutions, and countries identified in this study should take the initiative to conduct collaborative research and help less developed regions develop rapidly in this field; in addition, the high-impact publications summarised in this study can be used as standards and references for future research and determining international guidelines. Second, although WOS is a high-quality database, its coverage in fields such as engineering technology and social sciences is less extensive compared to databases like Scopus or Google Scholar. Consequently, our analysis may have missed significant literature from these areas. Additionally, WOS's inclusion criteria and emphasis on English-language publications may exclude non-English documents or those from certain regions, potentially affecting the understanding of global research trends. To minimize data bias, future studies should consider using multiple databases (e.g., WOS, Scopus, PubMed) for literature retrieval. This approach offers broader coverage and reduces the bias associated with relying on a single database. However, integrating data from various sources can be challenging due to issues like duplicate entries and differences in data formats. Proper deduplication and data consistency measures can enhance the accuracy of the analysis. Third, VOSviewer automatically extracts information related to the publication (author name, country, institution, and keywords), which may have caused extraction errors that led to inaccurate research results. Therefore, extraction results need to be carefully checked and standardised before conducting formal analyses. Finally, this study was only a preliminary analysis of the number, sources, and topics of published literature in this field, and showed the future development trends and hot directions of this field. However, clinicians focus more on clinical indicators related to surgery (such as treatment effects, clinical outcomes, and patient prognosis.). Future studies should conduct detailed and comprehensive evaluations for the therapeutic effects of MIGS from a clinical perspective to provide valuable guidance for clinical practice. For example, conducting high-quality meta-analyses and systematic reviews such as this study, which provides potential high-quality literature sources and research directions.

6 Conclusions

Technological innovations and developments should be based on available scientific evidence. This study was the first bibliometric analysis to provide an overview of publishing developments since the emergence of MIGS. This study also summarised MIGS progression and provides useful information for determining future research directions. Future studies should address potential challenges such as surgical safety, clinical deployment in low- and middle-income countries, and economic benefits.

Data availability statement

The data will be made available on request.

Financial support and sponsorship

10.13039/501100001809 National Natural Science Foundation of China (82130029 )

Presentation

None.

Ethical approval

Ethical approval is not applicable for this study.

CRediT authorship contribution statement

Ruyue Li: Writing – original draft, Methodology, Investigation, Formal analysis. Hanruo Liu: Writing – review & editing, Conceptualization. Kaiwen Zhang: Methodology. Zhecheng Lu: Methodology. Ningli Wang: Writing – review & editing, Supervision, Funding acquisition, Conceptualization.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Appendix A Supplementary data

The following is/are the supplementary data to this article:Multimedia component 1

Multimedia component 1

Acknowledgements statement

Assistantce with the study: none.

Appendix A Supplementary data to this article can be found online at https://doi.org/10.1016/j.heliyon.2024.e36591.
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