MIGS (Minimally Invasive Glaucoma Surgery)

MIGS (Minimally Invasive Glaucoma Surgery)

Minimally Invasive Glaucoma Surgery (MIGS) is a group of modern surgical techniques designed to lower eye pressure with significantly less trauma than traditional glaucoma surgeries. These procedures use microscopic incisions and specialized devices to improve fluid drainage, typically for patients with mild-to-moderate open-angle glaucoma who wish to reduce their dependence on daily eye drops.

When You Should Consider MIGS

• Mild-to-Moderate Glaucoma: When your eye pressure is not adequately controlled by one or two types of eye drops.

• Concurrent Cataract Surgery: MIGS is frequently performed alongside cataract removal, as it uses the same tiny incision and adds only minutes to the total procedure time.

• Intolerance to Medications: If you experience severe dry eye, redness, or allergies caused by long-term use of glaucoma eye drops.

• Desire for Faster Recovery: When you require a pressure-lowering procedure but cannot afford the long downtime associated with traditional surgery.

• Preserving Future Options: Because MIGS is "micro-invasive," it preserves the outer layers of the eye (conjunctiva) in case more intensive surgery is needed later in life.

How Is Performed

• Micro-Incision: The surgeon enters the eye through a microscopic incision (often only 1–2 mm) in the clear cornea.

• Ab Interno Approach: The procedure is performed from the inside of the eye, allowing the surgeon to view the internal drainage angle directly through a specialized lens.

• Methods of Treatment:
  Trabecular Bypass (Stents): Tiny implants like the iStent or Hydrus Microstent are placed into the eye's natural drainage canal to bypass blockages.
  Tissue Excision: Tools like the Kahook Dual Blade (KDB) are used to remove a small strip of the blocked meshwork to let fluid flow freely.
  Subconjunctival Filtration: A flexible gelatin tube, such as the Xen Gel Stent, creates a tiny tunnel to redirect fluid to a reservoir under the eye's outer membrane.
  Ciliary Body Ablation: A laser probe (ECP) is used inside the eye to treat the tissue that produces fluid, reducing the overall "inflow" of pressure.

• Duration: When performed alone, MIGS typically takes 10 to 15 minutes; when combined with cataract surgery, it adds approximately 5 to 10 minutes.

Pre-Procedure Preparation

• Gonioscopy: A detailed exam using a mirrored lens to view your internal drainage angle and ensure it is "open" enough for MIGS.

• Visual Field Mapping: Documenting your current peripheral vision to establish a baseline for long-term stability.

• Medication Audit: Reviewing your current eye drops; your surgeon will determine if you should continue or stop them immediately after the procedure.

• Transportation: Arranging for a ride home, as your vision may be temporarily blurry from the surgical microscope and dilating drops.

Tests Before MIGS

• Optical Coherence Tomography (OCT): To measure the thickness of the optic nerve fibers and assess the severity of glaucoma.

• Intraocular Pressure (IOP) Tracking: Recording your pressure at different times of the day to determine your "target pressure."

• Pachymetry: Measuring the thickness of your cornea to ensure the most accurate eye pressure readings.

• Endothelial Cell Count: Checking the health of the inner cornea, especially if a permanent stent is being considered.

Life After MIGS

• Rapid Recovery: Most patients return to normal daily activities within 3 to 7 days, which is much faster than traditional glaucoma surgery.

• Medication Regimen: You will need to use antibiotic and anti-inflammatory eye drops for several weeks to ensure proper healing.

• Pressure Monitoring: Temporary "pressure spikes" can occur in the first few days, requiring close follow-up with your surgeon.

• Activity Restrictions: Avoid heavy lifting, swimming, or rubbing the treated eye for at least 2 to 4 weeks.

• Reduced Drop Burden: Many patients are able to significantly reduce or even stop their daily glaucoma eye drops once the drainage device is fully functional.

Why Specialized Treatment Is Highly Effective

• High Safety Profile: Carries a much lower risk of serious complications like hypotony (dangerously low pressure) or severe bleeding.

• Versatile Pathways: Surgeons can target multiple drainage pathways (trabecular, uveoscleral, or subconjunctival) depending on your eye's unique anatomy.

• Standardized Precision: The use of microscopic stents and blades ensures a predictable result with minimal damage to healthy tissue.

• Sustained Control: Unlike eye drops, which can be forgotten or difficult to administer, a MIGS implant provides 24/7 pressure management.

• Synergy with Cataract Care: Offers a "two-for-one" opportunity to improve vision clarity and lower eye pressure in a single, efficient session.