MIGS

Minimally Invasive Glaucoma Surgery

In an effort to find alternative surgical means to control IOP with fewer potential side effects and faster recovery, new techniques and implants are being developed. These are collectively called MIGS: minimally invasive glaucoma surgery, and there have been recent news items concerning these. Most MIGS operations are designed to allow extra fluid to leave the eye, and hence lower the IOP.

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MIGS and its potential benefits for glaucoma patients.

• The Preserflo Micro Shunt. An ab-externo drainage system that helps reduce IOP. According to recent results it is as effective as trabeculectomy in lowering IOP in moderate to advanced glaucoma and reported to be less invasive with patients requiring less follow up or postoperative interventions.

The iStent® inject implant is a tiny device (less than 1mm) that is inserted through the trabecular meshwork into Schlemm’s canal, usually at the time of cataract surgery to aid fluid outflow. Previous variants had a different shape, like a periscope that is inserted sideways. (to find out more go to www.glaukos.com)

• The XEN® gel implant, on the other hand, drains fluid from the anterior chamber into the conventional surgical drainage space, the subconjunctival tissue. (to find out more go to  www.xengelstent.com)

• The Hydrus® is an implant that holds the canal open and helps outflow of fluid (find out more go to www.ivantisinc.com)

• Canaloplasty ‘tents’ the canal open by feeding in and then tying off a fine circumferential thread within the canal.

• Micropulse cyclodiode laser – which is a variation of an older external treatment called cyclodiode laser – is usually classed as a MIGS treatment.

Many of the MIGS procedures can be combined with cataract surgery. However, not all of these implants are currently available in New Zealand as there are safety and regulatory hurdles to be overcome before they can be released. Furthermore, there are significant financial considerations for the manufacturers (given that New Zealand is a relatively small market) and additional training required of surgeons in New Zealand in these new techniques. At the present time, iStent®, Hydrus®, Xen® and Micropulse cyclodiode laser have been introduced.

MIGS procedures may be particularly beneficial in:
1. People intolerant to eye drops because of side-effects or allergy
2. People unable to use eye drops for other health reasons
3. People having a cataract operation who has mild to moderate glaucoma who would like to decrease the number of drops they are using.

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