Glaucoma is a big problem, affecting 76 million people globally. It causes 8% of all blindness. This condition can damage the optic nerve if not treated. The main goal is to lower eye pressure to stop this damage.
Old treatments include eye drops, lasers, and surgeries like trabeculectomy. These can have serious side effects and need constant check-ups. A new option, minimally invasive glaucoma surgeries (MIGS), has been developed.
MIGS aim to lower eye pressure safely and with less harm to the eye. They are good for people with mild to moderate glaucoma. They also help those who can’t stick to treatment or have bad reactions to drugs.
Key Takeaways
- Glaucoma is a leading cause of blindness worldwide, affecting an estimated 76 million people.
- Intraocular pressure (IOP) is the main modifiable risk factor for glaucoma, and lowering IOP is the primary treatment goal.
- Minimally invasive glaucoma surgeries (MIGS) are a new class of procedures that aim to lower IOP with a high safety profile and minimal disruption to eye anatomy.
- MIGS can be considered for cases of mild to moderate glaucoma, noncompliance to treatment, or adverse drug reactions.
- MIGS procedures typically target the trabecular meshwork, uveoscleral outflow, or aqueous production to reduce IOP.
Introduction to Minimally Invasive Glaucoma Surgeries
Definition and Characteristics of MIGS
Minimally Invasive Glaucoma Surgeries (MIGS) are a new way to treat glaucoma. They are safe and have fewer risks than old methods. This is because they don’t hurt the eye as much.
MIGS are done through a small cut in the clear part of the eye. This lets doctors see and work on the eye’s inner parts. These surgeries can lower eye pressure by 20% or more. They are also easy for patients and doctors, with quicker healing times.
Benefits of MIGS over Traditional Glaucoma Surgeries
MIGS are better than old glaucoma surgeries in many ways. They have fewer risks of serious problems. They also don’t hurt the eye as much, which means quicker healing and happier patients.
Another plus is that MIGS can be done at the same time as cataract surgery. This makes things easier for patients and saves time. Overall, MIGS are a safer and more effective way to manage glaucoma.
“MIGS have emerged as a promising approach in glaucoma management, offering a more favourable safety profile compared to traditional glaucoma surgeries.”
What are minimally invasive glaucoma surgeries?
Minimally invasive glaucoma surgeries (MIGS) are new ways to treat glaucoma. They aim to lower eye pressure by improving how fluid moves out of the eye. This can be done in several ways, like bypassing certain parts of the eye or changing how fluid is made.
MIGS is safer and less invasive than older surgeries. It doesn’t harm the eye as much. This makes it a good option for many people with glaucoma.
MIGS has become popular because it’s safer than older surgeries. It includes mini versions of old surgeries and new devices like Xen Gel Stent and PRESERFLO Microshunt. These new tools help lower eye pressure better than some older methods.
Trabecular surgeries like Trabectome and Trab360 are approved by the FDA. They work well for people in the early to moderate stages of glaucoma. Suprachoroidal shunts, like Glaukos shunts, are also effective, even for those with more severe glaucoma.
New laser treatments are also being used. They help in the early stages of glaucoma. These treatments are less invasive and can be more effective.
MIGS is a recent breakthrough in treating glaucoma. It’s used when eye drops and pills aren’t enough. MIGS doesn’t need eye drops and recovery is faster than older surgeries.
“MIGS procedures can reduce intraocular pressure by at least 20% and offer minimal tissue trauma.”
There are different MIGS procedures, like Microtrabulectomy and laser surgery. While rare, infections can happen. Still, MIGS is a safe and effective choice for many with mild to moderate glaucoma.
Approaches to Minimally Invasive Glaucoma Surgery
One main way in minimally invasive glaucoma surgeries (MIGS) is to boost aqueous outflow. This is done by focusing on the trabecular meshwork, the key area where aqueous drainage is blocked. Several methods can help:
- Trabecular meshwork bypass using stents to let aqueous flow from the anterior chamber into Schlemm’s canal;
- Removing trabecular meshwork tissue to improve outflow into Schlemm’s canal;
- Expanding Schlemm’s canal with viscoelastic to enhance normal aqueous outflow.
Another MIGS method is to increase outflow through the uveoscleral pathway. This is done by placing a microstent in the suprachoroidal space. It allows aqueous to bypass the trabecular meshwork and drain through this new route.
If traditional outflow paths won’t work, MIGS can also involve shunting aqueous humour into the subconjunctival space. This is done through a small incision made from the inside. It creates a new drainage path for the aqueous.
The last MIGS approach is to cut down aqueous production. This is done by removing part of the ciliary body, which makes aqueous humour. Endocyclophotocoagulation uses a laser to directly target and remove the ciliary processes.
“MIGS offers good post-operative recovery with minimal downtime for patients and ease for surgeons, making it a promising option in glaucoma management.”
MIGS Devices and Procedures
Minimally Invasive Glaucoma Surgeries (MIGS) have changed how we treat glaucoma. They offer new ways to manage this eye condition. Key MIGS devices, like trabecular meshwork bypass stents, help drain fluid and lower eye pressure.
Trabecular Meshwork Bypass Stents
Stents like the iStent, iStent inject, and Hydrus microstent are tiny. They are made of titanium and coated with heparin. These stents are placed in the trabecular meshwork and Schlemm’s canal. They help fluid drain better.
Trabecular Meshwork Tissue Excision
Removing or cutting the trabecular meshwork tissue is another MIGS method. Procedures like Kahook Dual Blade Goniotomy and Trabectome do this. They help fluid drain into Schlemm’s canal.
MIGS devices and procedures are a less invasive option for glaucoma patients. They can reduce eye pressure, need for eye drops, and recovery time. As MIGS advances, more options will be available to treat glaucoma effectively.
Indications for MIGS
Minimally Invasive Glaucoma Surgeries (MIGS) are for those with mild to moderate glaucoma. They help when eye drops and laser treatments don’t work well. MIGS is also for those who can’t or won’t use eye drops.
It’s also used with cataract surgery to cut down on medication. This is for patients whose glaucoma is well-managed.
Studies show MIGS is effective in lowering eye pressure and reducing medication needs:
- At 24 months, 61% of patients with iStent and cataract surgery kept their IOP below 21mm Hg without medication. This was compared to 50% in the control group.
- For iStent Inject with cataract surgery, 75.8% of patients saw a ≥20% drop in medication-free IOP at 24 months. This was higher than 61.9% in the control group.
- The Hydrus Microstent with phacoemulsification led to 80% of patients having a 20% IOP drop at 24 months. This was more than the 46% in the phacoemulsification alone group.
- A study comparing Hydrus Microstent to two iStent devices showed Hydrus had a higher success rate. 46.6% of Hydrus users didn’t need medication, compared to 24% for iStent.
These results show MIGS is a good option for patients with mild to moderate glaucoma, uncontrolled IOP, medication intolerance, or patient non-compliance. It can be done alone or with cataract surgery.
Contraindications for MIGS
Minimally Invasive Glaucoma Surgeries (MIGS) have changed how we treat glaucoma. They offer a gentler option compared to older surgeries. But, not everyone can have MIGS. Some conditions make it risky or less effective.
Angle-closure glaucoma is a big no for MIGS. These patients face blockages that stop the fluid from flowing out. Neovascular glaucoma is also a no-go because of the risk of bleeding and scarring.
Those with corneal opacity or angle dysgenesis might not be good candidates. These issues make it hard for surgeons to see and work on the needed areas. Also, elevated episcleral venous pressure from conditions like Sturge-Weber syndrome can make MIGS less effective.
- Angle-closure glaucoma
- Neovascular glaucoma
- Corneal opacity
- Angle dysgenesis
- Elevated episcleral venous pressure (e.g., Sturge-Weber syndrome, thyroid eye disease, retrobulbar tumours)
Doctors must look closely at each patient’s situation before deciding on MIGS. Knowing what doesn’t work for MIGS helps doctors give the best care for glaucoma.
“The success of MIGS procedures is highly dependent on patient selection, and understanding the contraindications is crucial to optimising outcomes and minimising the risk of complications.”
Surgical Technique of MIGS Procedures
Minimally invasive glaucoma surgeries (MIGS) are done through a small clear corneal incision. This method lets the surgeon see and work on specific parts like the trabecular meshwork and Schlemm’s canal. It’s all done with an ab interno technique.
For trabecular meshwork bypass surgeries, tiny stents are put into the trabecular meshwork and Schlemm’s canal. This helps the fluid in the eye to flow better. Suprachoroidal stent placement increases the flow of fluid through the uveoscleral pathway. Endocyclophotocoagulation reduces fluid production by treating the ciliary body.
The exact method used depends on the MIGS device or procedure. Some common ones include:
- iStent and iStent inject: Tiny stents are implanted to improve fluid flow.
- Hydrus Microstent: An 8mm stent is placed to widen Schlemm’s canal.
- XEN Gel Stent: A subconjunctival device is used to drain fluid.
- Endocyclophotocoagulation: Laser treatment is used to lower fluid production.
These methods aim to lower eye pressure with less damage and fewer complications than traditional surgeries.
| MIGS Procedure | Surgical Technique | Target |
|---|---|---|
| Trabecular Meshwork Bypass | Implantation of tiny stents into the trabecular meshwork and Schlemm’s canal | Enhance aqueous outflow |
| Suprachoroidal Stent Placement | Placement of a stent in the suprachoroidal space | Increase uveoscleral outflow |
| Ciliary Body Ablation | Targeted laser treatment to reduce aqueous production | Decrease aqueous humour production |
The techniques used in MIGS aim to tackle glaucoma’s causes. They offer a less invasive way to lower eye pressure and may reduce the need for long-term eye drops.
Risks and Complications of MIGS
Minimally invasive glaucoma surgeries (MIGS) are safer than old glaucoma treatments. Yet, they can still cause problems. These include stent displacement or obstruction, and other issues like transient intraocular pressure elevation.
Even so, serious side effects are much rarer with MIGS than with older surgeries. Choosing the right patient and doing the surgery carefully can help avoid big problems.
The iStent, a tiny titanium device, helps many patients stop using glaucoma meds after 23 months. The iStent Inject, used with cataract surgery, also lowers eye pressure well. The Trabectome, approved in 2006, helps treat open-angle glaucoma by improving fluid flow.
The Omni360 Glaucoma Treatment System does two MIGS steps in one surgery. The XEN Gel Stent, a soft gel stent, helps drain fluid without cuts. Endocyclophotocoagulation (ECP) targets ciliary body cells to cut down fluid production.
At the Assil Gaur Eye Institute, MIGS like iStent and others are often done with cataract surgery. Dr. Avneet K. Sodhi Gaur performs these surgeries.
MIGS devices can slightly lower intraocular pressure (IOP). However, they are quite expensive, with some costing over US $400.
Schlemm’s canal devices, like the Hydrus, can lead to better control of glaucoma and lower IOP. The CyPass MicroStent, a suprachoroidal device, was taken off the market due to eye damage.
Subconjunctival devices, such as the XEN-45, might cause fibrosis or other issues. MIGS might not work as well for advanced glaucoma. Glaucoma drainage devices, on the other hand, are cheaper, starting at US $50.
It’s important to compare different MIGS devices to see which works best. More studies, especially long-term ones, are needed to fully understand MIGS safety and effectiveness.
Outcomes and Efficacy of MIGS
Minimally Invasive Glaucoma Surgeries (MIGS) show great promise. They help lower intraocular pressure (IOP) and cut down on medication for those with open-angle glaucoma. Research shows MIGS can drop IOP by at least 20% and lessen the need for glaucoma meds.
The iStent inject, a small stent, has been effective. It lowers IOP by an average of 34% and cuts medication use from 1 to 0.1. The Synergy study found 74% of patients saw a 20% or more IOP drop at 12 months post-surgery, still needing some meds.
Even though MIGS are new, early data looks good. They seem to offer meaningful IOP drops and better patient satisfaction than old glaucoma surgeries. A 2017 review and meta-analysis on MIGS for open-angle glaucoma also backs their effectiveness.
| Procedure | IOP Reduction | Medication Reduction | Patient Satisfaction |
|---|---|---|---|
| iStent inject | 34% | 90% reduction (from 1 to 0.1 medications) | High |
| Trabectome | 25-35% | Reduced by an average of 1 medication | Moderately high |
| Kahook Dual Blade | 20-30% | Reduced by an average of 1 medication | High |
More research is needed to fully understand MIGS. Studies and trials are ongoing. They aim to prove MIGS’ benefits for MIGS IOP reduction, medication burden reduction, and patient satisfaction.
MIGS in Combination with Cataract Surgery
Minimally Invasive Glaucoma Surgeries (MIGS) can be combined with cataract surgery. This offers a more complete treatment for patients. It also means less surgery and less need for eye drops.
Surgeons can use a trabecular meshwork bypass stent or another MIGS procedure during cataract surgery. This helps to lower eye pressure. It’s good for people with mild to moderate glaucoma and cataracts.
This combined surgery is safer because it uses the same anaesthesia. It’s also cheaper than doing each surgery separately. Plus, it uses just one incision, which is less invasive.
But, not everyone can have this surgery. The doctor will check how bad the glaucoma and cataracts are. They’ll also look at the eye’s health to decide the best treatment.
New MIGS devices, like the iStent and Xen gel stent, work well with cataract surgery. They help control eye pressure and reduce the need for eye drops. This makes the treatment more focused and improves vision.
The use of MIGS with cataract surgery is growing. It’s a good option for those with both glaucoma and cataracts. It makes surgery less and can lower the need for eye drops. This improves life quality for those with these common eye issues.
Conclusion
Minimally invasive glaucoma surgeries (MIGS) are a big step forward in treating glaucoma. They are safer and less invasive than old methods. They help lower eye pressure and cut down on medication for patients.
MIGS work by improving how fluid moves out of the eye or by reducing fluid production. This leads to better eye pressure control. It also means patients can recover faster and with fewer side effects.
MIGS are becoming more important in treating glaucoma. They might cost more than some other treatments, but they can be very effective. They are especially useful when used with cataract surgery.
Looking ahead, MIGS will likely play a big part in managing glaucoma. They offer a more precise and tailored treatment option. This is good news for those living with glaucoma.
In summary, MIGS are safer and more effective than traditional surgeries. They reduce the need for medication and help patients recover faster. As they continue to evolve, MIGS will be key in the future of glaucoma treatment.
FAQ
What are minimally invasive glaucoma surgeries (MIGS)?
MIGS are new surgeries for glaucoma. They aim to lower eye pressure. These surgeries work on how fluid moves in the eye to help reduce pressure.
What are the key characteristics of MIGS?
MIGS are safe and don’t harm the eye much. They use a small cut in the clear part of the eye. They can lower eye pressure by 20% or more. Patients and doctors find them easy to use, and recovery is quick.
What are the benefits of MIGS over traditional glaucoma surgeries?
MIGS are safer and cause less damage. They help eyes heal faster. Patients are happier with MIGS. They can also be done with cataract surgery, making things easier for patients.
What are the different approaches in MIGS?
MIGS work in different ways. Some help fluid move out of the eye. Others help fluid move through the eye differently. Some even help by changing how fluid is made.
What are some common MIGS devices and procedures?
Some common MIGS include stents and special tools. For example, the iStent and the Kahook Dual Blade Goniotomy. These help fluid move better in the eye.
What are the indications for MIGS?
MIGS are for people with mild to moderate glaucoma. They’re for those who can’t control eye pressure with drops or laser. They’re also for those who can’t use eye drops.
What are the contraindications for MIGS?
MIGS aren’t for everyone. They’re not for angle-closure glaucoma or certain other types. They’re also not for people with certain eye problems.
What are the potential risks and complications of MIGS?
MIGS can cause some problems. These include stent issues and eye pressure changes. But serious problems are much rarer than with older surgeries.
How effective are MIGS in lowering intraocular pressure and reducing medication burden?
MIGS can really help with eye pressure. For example, the iStent inject can lower pressure by 34%. It also means fewer eye drops are needed.
Can MIGS be combined with cataract surgery?
Yes, MIGS can be done with cataract surgery. This makes things easier for patients. It also means they might need fewer eye drops.
