MIGS
(minimally invasive glaucoma surgery)

The goal of this surgery is to lower the eye pressure in order to prevent or reduce damage to the optic nerve.  This type of surgery is typically safer than traditional glaucoma surgery such as trabeculectomy or a glaucoma drainage implant, with quicker recovery times and less likelihood of additional surgical complications. 

Types of MIGS procedures:

OMNI procedure: This is a two-part minimally invasive glaucoma surgery that can be done independently or at the time of cataract surgery. The goal of the surgery is to be able to treat nearly the entire drainage outflow structure of the eye during the procedure. First, a small caliber cannula is used to dilate the drainage canal of the eye, known as Schlemm’s canal in a process that uses a material known as a viscoelastic to accomplish the dilation. Next, the same cannula is used to remove a portion of the trabecular meshwork, allowing more direct access for fluid to drain directly into Schlemm’s canal, and thereby improving the effectiveness of the eye’s drainage system, allowing the intraocular pressure to be lowered. Almost all types of glaucoma are candidates for this surgery, and patients are often able to reduce the number of glaucoma drops they are on after surgery.

Xen Gel Stent: This is a porcine stent approximately 6 mm in length made by the Allergan company that can be implanted beneath the conjunctiva, or outer skin layer of the eye. This stent allows a controlled drainage of fluid from the front of the eye (anterior chamber) out to the area beneath the conjunctiva, forming what is known as a bleb, or fluid reservoir. This is a very safe and effective surgery, especially for patients with difficult-to-treat glaucoma such as pseudoexfolation glaucoma, or other types of glaucoma that can be hard to lower the pressure sufficiently using only medications. After Xen gel stent surgery, many patients are able to reduce or eliminate their glaucoma drops altogether, although this can depend on how well the eye responds to the surgery. Another large advantage to this surgery is that there is minimal recovery time after surgery until vision returns to the state it was prior to surgery, often allowing patients who only see well from one eye to undergo surgery safely on their better-seeing eye. Finally, this surgery can be done independently or with cataract surgery.

Micropulse laser:  This type of diode laser is used to reduce production of the eye’s natural fluid called aqueous humor.   This is done by lasering the ciliary body’s secretory epithelium, the location of the eye’s fluid production.  Less fluid production typically allows the eye to have lower pressure over time; there may also be added benefit from this laser to improve the aqueous outflow, or drainage.  With this dual mechanism of action, the eye can typically have a reduction in pressure and more protection against the damaging effects of glaucoma.   This type of laser is suited to most patients, especially those who have already had other glaucoma surgery and may not be candidates for additional incisional surgery.  This surgery is done as an outpatient procedure and typically has minimal downtime, often with rapid recovery of pre-operative vision.  There is minimal pain with this laser as there is anesthesia applied at the time of surgery while you are briefly asleep.   

Selective laser trabeculoplasty: SLT This is an in-office laser procedure designed to deliver laser energy to the trabecular meshwork. Here, pigmented cells selectively absorb this energy and thereby this laser avoids additional thermal damage to adjacent tissue and structures. Through this energy absorption, the trabecular meshwork is activated to function more efficiently in drainage of fluid from the eye, thereby lowering the eye’s effective intraocular pressure. This procedure can often be used interchangeably with glaucoma eye drops, and can typically be as effective as a primary treatment to lower the eye’s intraocular pressure.

iStent : The iStent is a trabecular meshwork micro-bypass device from Glaukos corporation designed to lower the intraocular pressure through implantation at the time of cataract surgery. The iStent creates a new drainage pathway to optimize the flow of fluid from the chamber in the front of the eye to the channel that directs fluid out of the eye by bypassing the tissue that the fluid normally flows through (and where this flow is often slower over time as we age). This is only indicated to treat open angle glaucoma and can only be implanted at the time of cataract surgery.

iStent Infinite: The iStent Infinite Trabecular Micro-Bypass System implanted in patients with open angle glaucoma (uncontrolled by prior surgical or medical therapy) was effective in reducing mean diurnal intraocular pressure with a favorable safety profile. The novel system is indicated for use in a standalone procedure to reduce elevated intraocular pressure (IOP) in patients with primary open-angle glaucoma uncontrolled by prior medical and surgical therapy. The iStent infinite includes three heparin-coated titanium stents preloaded into an auto-injection system that allows the surgeon to inject stents across a span of up to approximately six clock hours around Schlemm’s canal, the eye’s primary drainage channel. The iStent infinite has a similar mechanism of action to the company’s two-stent iStent inject W trabecular micro-bypass system, which is approved by the FDA for the reduction of IOP in adult mild-to-moderate primary open-angle glaucoma patients undergoing concomitant cataract surgery. Learn More

Hydrus: The Hydrus microstent is a minimally invasive glaucoma surgery (MIGS) device designed to lower the intraocular pressure (IOP) through implantation at the time of cataract surgery while avoiding the complications of traditional glaucoma filtration surgeries. Hydrus microstent’s intuitive delivery system allows for a straightforward procedure with immediate visual confirmation of successful implantation. The Hydrus microstent is unique among the MIGS devices in that it provides both trabecular bypass and scaffolding of a three-clock-position arc of Schlemm’s canal, placing the trabecular meshwork on stretch and providing enhanced access of aqueous humor to downstream collector channels. Learn More