Minimally Invasive Glaucoma Surgery
Advanced Treatment for Glaucoma
Minimally Invasive Glaucoma Surgery (MIGS) has been developed to treat glaucoma patients earlier and more safely than conventional surgery. These procedures involve microsurgical instruments and smaller incisions, which reduce the risk of complications. Although MIGS procedures offer increased safety, they are generally less effective than traditional surgeries.
How MIGS Procedures Work
MIGS procedures enhance fluid outflow from the eye, either within the eye’s drainage system or by carrying fluid outside the eye. Some MIGS procedures are performed only in conjunction with cataract surgery, while others can be done independently. Cataract surgery alone can lower intraocular pressure (IOP), and combining it with MIGS can further reduce the need for medication. Implanting a MIGS device adds only a few minutes to the cataract surgery.
Types of MIGS Procedures
MIGS procedures and devices are categorized based on their mechanism of action:
- Miniaturized Versions of Trabeculectomy: These procedures involve inserting tiny tubes into the eye to drain fluid to the outer membrane of the eye (conjunctiva). Examples include the FDA-cleared XEN Gel Stent and the PRESERFLO MicroShunt (formerly InnFocus), which is cleared outside the US.
- Angle-Based Surgeries: These procedures use specialized instruments to modify the eye’s drainage canals (trabecular meshwork, Schlemm’s canal, and collector channels) to improve fluid drainage. Techniques include:
- Cutting through the trabecular meshwork (e.g., Trabectome, Kahook Dual Blade, OMNI Surgical System).
- Bypassing the trabecular meshwork by placing a stent in the Schlemm’s canal (e.g., iStent Inject, Hydrus Microstent).
- Expanding the Schlemm’s canal and collector channels with a gel (e.g., iTrack, OMNI Surgical System).
Different angle-based MIGS procedures can be combined to enhance fluid drainage from the eye.
Conventional Surgeries vs. MIGS
While conventional surgeries like trabeculectomy or aqueous shunts, more powerfully lower IOP preventing glaucoma progression, they come with longer rehabilitation time and higher potential complications. MIGS, on the other hand, provides IOP reduction with significantly improved safety profile and more rapid recovery, making them suitable for patients with mild to moderate primary open-angle glaucoma (POAG).
Ideal Candidates for MIGS
The best candidates for angle-based MIGS are those with mild to moderate POAG and patients who experience side effects from medical therapy or those who have undergone other procedures but still have elevated IOP.
Who Performs MIGS?
MIGS procedures are performed by ophthalmologists, particularly glaucoma specialists, as part of a range of treatment options available to their patients.
Combining MIGS and Cataract Surgery
Combining MIGS with cataract surgery can offer a comprehensive approach to managing both cataracts and glaucoma, potentially improving overall visual outcomes and quality of life for patients. Performing MIGS at the same time as cataract surgery can reduce the need for multiple surgeries.
Comparing MIGS to Traditional Surgery
Compared to traditional glaucoma surgeries such as trabeculectomy and aqueous drainage devices, MIGS offers a lower efficacy but a better safety profile. For many patients with mild to moderate glaucoma, MIGS provides sufficient IOP reduction while minimizing the risk of severe complications associated with traditional surgeries.
At Mid Florida Eye Center, we are dedicated to offering the latest and safest treatments for glaucoma. If you are interested in learning more about MIGS or determining if you are a candidate for this procedure, please contact us to schedule a consultation.
