Minimally Invasive Glaucoma Surgery

Dr. Russel Lazarus, October 3, 2021

Minimally invasive glaucoma surgery, commonly called MIGS, is an advanced approach to glaucoma treatment.

Glaucoma is a group of eye diseases that damage the optic nerve, usually as a result of high intraocular pressure. While there is currently no cure for glaucoma, MIGS can help lower eye pressure to prevent optic nerve damage and loss of vision.

What are MIGS?

While a range of glaucoma treatment options exist, for many, a MIGS procedure can be most effective at lowering eye pressure.

MIGS are tiny devices that are inserted into the eye to lower eye pressure.

This procedure is less invasive than standard glaucoma surgery, has a shorter recovery time for patients with mild to moderate glaucoma, and leads to fewer complications than traditional surgical methods.

A MIGS procedure is also a viable choice for those who want to reduce their daily reliance on glaucoma eye drops and medication.

Types of MIGS

1. Microtrabeculectomy

A micro trabeculectomy is a procedure that involves placing microscopic tubes into the eye to enable proper drainage of eye fluid.

There are two devices that are most frequently used: the Xen Gel Stent and the PRESERFLO Microshunt (previously known as INNFocus).

These devices are safe and effective in lowering eye pressure, especially when compared to traditional trabeculectomy surgery.

2. Trabecular surgery

The trabecular meshwork is frequently the main source of fluid drainage obstruction.

Several procedures have been designed to cut through the trabecular meshwork in order to widen the fluid drainage pathway.

Trabecular surgery is performed under high-power microscopy. This procedure involves cutting a microscopic-sized hole in the meshwork and implanting a tiny snorkel-shaped device.

The most commonly used devices are the iStent and Trabectome or Trab360.

These procedures are most effective for early to moderate stages of glaucoma, as they produce only a limited reduction in eye pressure.

3. Suprachoroidal shunts

Suprachoroidal shunts are small tubes that are implanted into the suprachoroidal space, between the retina and outerwall of the eye, to promote fluid drainage from the eye.  As the fluid drains, the eye pressure is reduced.

This method is effective for moderate to severe cases of glaucoma and has a low rate of serious complications.

SEE RELATED: What is Glaucoma?

If you have glaucoma, schedule an appointment with an eye doctor near you to determine if MIGS is right for you.

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Preparing for MIGS

To determine if MIGS can treat your glaucoma, your eye doctor will perform several diagnostic tests. If you are a candidate for MIGS, your doctor will use these tests to decide which device or technique is most appropriate for you.

Prior to your MIGS procedure, your eye doctor will provide detailed pre-procedure guidelines, which may include adding or discontinuing certain eye drops from your daily regimen.

Be sure to arrange for someone to drive you to and from your surgery.

The MIGS procedure

MIGS is an outpatient procedure. In most cases, a local anesthetic or numbing eye drop will be given, along with IV sedation supplied by an anesthesiologist.

Many MIGS procedures are designed to be performed in conjunction with cataract surgery. This means that the same incision used to remove your cataract will also be used to implant your microdevice.

Recovery after MIGS

How quickly you recover will depend on the type of procedure you’ve had and your medical history.

One of the advantages of a MIGS procedure is that the recovery time is significantly less when compared to standard surgery — but still expect a recovery time of up to several days or weeks. 

Your eye doctor will schedule a follow-up appointment for you and provide you with post-procedure instructions that may include lifestyle modifications, such as precautions when it comes to driving and returning to work.

After about 6-8 weeks most MIGS patients can expect to see an improvement in intraocular pressure.

Who is a candidate for MIGS?

To determine if you are a candidate for MIGS, your eye doctor will evaluate both your medical history and current glaucoma management plan.

An ideal candidate for MIGS will typically have early to moderate open-angle glaucoma and be interested in undergoing cataract surgery.

However, MIGS options are still available for patients who do not need cataract surgery.

LEARN MORE: Guide to Eye Conditions 

If you have glaucoma, schedule an appointment with an eye doctor near you to determine if MIGS is right for you.

MIGS are tiny devices that are inserted into the eye to lower eye pressure.

A MIGS procedure can be more effective than other glaucoma treatments and less invasive than standard glaucoma surgery.