Minimally invasive glaucoma surgery (MIGS) is the name given to a group of keyhole glaucoma surgeries that can be used as an alternative to eye drops or more invasive conventional glaucoma surgery (trabeculectomy and tube surgery).
As MIGS has improved safety compared to conventional surgery MIGS can be offered at an earlier stage of disease. MIGS is often combined with cataract surgery meaning vision can often be improved and glaucoma better controlled with one day case procedure.
Benefits of MIGS
Advantages of MIGS compared to conventional glaucoma surgery
- Shorter surgery time
- No stitches
- Quicker recovery time
- More comfortable
- Fewer visits needed after surgery
- Easily combined with cataract surgery
Advantages of MIGS compared to eye drops
- Reduces potential for side effects caused by medication
- More convenient
- Greater freedom
- No need to worry about forgetting medication
- Better 24-hour control of intraocular pressure
- Combined with cataract surgery can improve vision
Types of MIGS
The iStent is the smallest implantable device approved for use in the human body. It's a titanium device that is implanted from inside of the eye (an ab interno approach) into the trabecular meshwork (the drainage channel of the eye) to bypass it and improve outflow of eye fluid. iStents are typically implanted during the time of cataract surgery, and in some cases more than one iStent is implanted. Although iStent does not have the same power to reduce intraocular pressure compared to more invasive procedures, it has a good safety profile and may be considered for patients with mild to moderate disease, particularly those who also require cataract surgery.
Xen gel stent
The Xen gel stent is a device that can lower intraocular pressure and reduce the need for eye drops without the risk of conventional glaucoma surgery. It is a soft, gelatin implant 6mm and the width of a human hair. In a pivotal study the Xen lowered average intraocular pressure from 25mmHg to 16mmHg with the number of eye drops needed for glaucoma reduced from an average of 3.5 to 1.7. The Xen stent is implanted during a short procedure under local anaesthesia.
Laser eye surgery (SLT)
Selective laser trabeculoplasty (SLT) is a minimally invasive procedure which can be used at any stage of glaucoma or in people without glaucoma who have raised intraocular pressure. SLT, which takes about 10 minutes to complete, is almost painless. It involves directing a gentle laser beam at the eye’s natural drainage channel (the trabecular meshwork). 70 to 80% of people will have a reduction in intraocular pressure which can reduce the need for eye drops. SLT is often performed as an alternative to eye drops in people newly diagnosed with glaucoma.
Cataract surgery can be a very effective treatment for glaucoma, particularly for patients with a type of glaucoma known as angle closure glaucoma. A recent large study published in the Lancet, the EAGLE study, showed surgery to remove the lens, could result in better outcomes than more traditional treatments for patients with angle closure. The added benefit of cataract surgery is that it can reduce the need for spectacles and lead to improved vision. Advanced lens technologies are also available to further improve results.
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