Five-year trends in primary open-angle glaucoma surgery: baseline characteristics preferences, and the impact of emerging techniques.

PURPOSE: To evaluate the baseline characteristics of patients with open-angle glaucoma (OAG) who underwent primary glaucoma surgery between 2020 and 2024, and to analyze trends in surgical preferences. METHODS: Medical records of patients older than 18 years who underwent primary glaucoma surgery were reviewed retrospectively. Surgical procedures included trabeculectomy, Ahmed Glaucoma Valve (AGV) implantation, gonioscopy-assisted transluminal trabeculotomy (GATT), Kahook Dual Blade (KDB), XEN Gel Stent implantation, and diode laser cyclophotocoagulation. RESULTS: A total of 1,192 eyes were included, and the annual number of operated eyes was 158 in 2020, 231 in 2021, 245 in 2022, 326 in 2023, and 232 in 2024. Age, IOP, BCVA, and glaucoma stage were similar across the years (all p > 0.05), whereas the number of preoperative medications was higher in 2020 than in the following years (p < 0.01). Across all years, surgery was performed most frequently in eyes with severe glaucoma, and trabeculectomy remained the most common procedure. In 2023 and 2024, the frequencies of trabeculectomy and AGV implantation decreased, whereas GATT increased and became the third most commonly performed procedure. The minimally invasive glaucoma surgery (MIGS) group included more mild-to-moderate cases and fewer severe cases, and had better BCVA and lower IOP than the non-MIGS group (all p < 0.05). CONCLUSIONS: Baseline characteristics remained largely stable over the five-year period, except for higher preoperative use of antiglaucoma medications in 2020. Surgical practice shifted toward GATT and MIGS in 2023 and 2024. Compared with the non-MIGS group, the MIGS group included a higher proportion of eyes with mild-to-moderate disease, while trabeculectomy remained the most commonly performed procedure overall.