Background: Glaucoma, a leading cause of blindness worldwide, can be managed surgically when medical treatments are insufficient. Trabecular meshwork (TM)-based micro-invasive glaucoma surgery (MIGS) has emerged as a less invasive surgical approach to lowering intraocular pressure (IOP) and managing glaucoma. Methods: This narrative review synthesizes the scientific literature and trials on TM-based MIGS techniques, including trabecular micro-bypass stents, goniotomy and trabeculotomy procedures, electrocautery and laser-based approaches, and ab interno canaloplasty. Among these techniques, efficacy, pivotal clinical trials, medication reduction, safety profiles, complications, and determinants of surgical success were examined. Results: While all TM-based MIGS devices assessed achieved meaningful IOP reduction compared with trabeculectomies, there was no consensus on which TM-based MIGS technique yielded the best outcomes. TM-based MIGS had a good safety profile compared with traditional glaucoma surgeries. Common postoperative complications included transient hyphema, corneal edema, and anterior chamber inflammation. Ultimately, the success of TM-based MIGS procedures depended on many factors, including surgical technique, device type, and patient-specific factors. Conclusions: TM-based MIGS are an effective and safe surgical management option for eligible glaucoma patients requiring moderate IOP reduction. Future research should focus on the long-term outcomes of MIGS procedures, compare MIS devices, and explore the mechanistic and histopathological changes induced by MIGS.

Background/Objectives: Inherited retinal diseases (IRDs) represent a group of rare conditions characterized by significant clinical and genetic heterogeneity. Historically, the diagnosis of these conditions relied primarily on clinical presentation and imaging techniques. This literature review aims to discuss the current state of progress and ongoing challenges in applying precision medicine approaches to IRDs and to examine how advances in genetic testing have transformed diagnostics and opened new therapeutic avenues. Methods: This review examines the application of genetic testing methods to IRDs, with particular focus on next-generation sequencing (NGS) technologies. The review also evaluates current patient selection protocols that combine genetic confirmation, retinal structural evaluation, and detailed genetic counselling to achieve optimal therapeutic outcomes. Results: The implementation of NGS has significantly enhanced diagnostic capabilities for IRDs by enabling precise identification of specific genetic mutations. This advancement has paved the way for targeted therapeutic strategies, exemplified by Luxturna for RPE65-related IRDs. However, several barriers to broader adoption of precision medicine persist, including high costs, varied access to services, and complexities in interpreting genetic variants. Conclusions: While the continued development of innovative therapeutic modalities offers promise for expanding treatment options for IRDs, fully harnessing the potential of current and emerging therapeutic technologies requires addressing existing economic, technological, educational, and infrastructural challenges.

Purpose: To evaluate the bidirectional association between obstructive sleep apnea (OSA) and keratoconus (KC) in young adults using matched-cohort designs. Methods: Multicenter retrospective cohort study using the TriNetX Research Network. In the forward direction, adults aged 18 to 45 with OSA (ICD-10: G47.33) and evidence of polysomnography were compared with 3 propensity-score–matched comparators: polysomnography-evaluated controls, with and without age restriction, and a general encounter control. In the reverse direction, patients with KC and evidence of corneal imaging (H18.6 with topography, anterior segment OCT, or pachymetry) were compared with 3 parallel cohorts. Comparisons used 1:1 propensity-score matching (caliper 0.2) on demographics, body mass index strata, atopic/metabolic comorbidities, and health care utilization. Hazard ratios (HRs) were estimated at 5 and 10 years. Acute appendicitis served as the prespecified negative control outcome in all comparisons; ingrown nail was additionally evaluated in the general encounter comparator. Results: The forward primary analysis matched 48,954 patients per arm. The 5-year HR for incident KC was 2.01 (95% CI: 1.21–3.32; P = 0.006), stable at 10 years (HR: 2.03, 1.28–3.21), with concordant sensitivity HRs of 1.72 and 1.88. The reverse primary analysis matched 4350 patients per arm. The 5-year HR for incident OSA was nonsignificant (HR: 1.13, 0.91–1.40); the 10-year HR was 1.29 (1.07–1.55; P = 0.008). The negative control was null in all primary comparisons. The E-value for the forward primary HR was 3.45. Conclusions: OSA with evidence of polysomnography was associated with incident KC after adjustment for measured confounders. The reverse direction showed a weaker, time-delayed association requiring cautious interpretation given detection bias. These findings support consideration of sleep evaluation in young adults with suspected corneal ectatic disease; they do not address whether treating OSA alters progression in established KC.