Micro Invasive Glaucoma Surgery (MIGS)

Micro Invasive Glaucoma Surgery (MIGS) is one of the latest treatments that has been developed for the surgical management of glaucoma.

Glaucoma is a disease that damages your eye’s optic nerve, the neural “signal cable” that allows the visual information from the eye to be transmitted to the brain so that you can see. It results in progressive loss in your peripheral or side vision, and can eventually cause blindness. Glaucoma is usually caused by higher pressure inside the eye (intraocular pressure or IOP), which causes stress on the optic nerve and thus progressive loss of the nerve fibres. All current treatments (medicine, laser and surgery) for glaucoma are aimed at lowering this eye pressure in order to protect vision. MIGS procedures have been developed as an effective way of reducing the intraocular pressure in a much safer way than traditional glaucoma surgery such as trabeculectomy.

There are several MIGS devices available such as iStent inject (Glaukos Corp), Hydrus Microstent (Ivantis Inc) and the XEN Gel implant (Allergan). These devices are all surgically implanted in a micro-invasive approach with the goal of allowing improved drainage of the fluid from inside the eye to the outside, and thereby lowering the eye pressure. There are various advantages and disadvantages of each device. iStent inject is a microscopic titanium stent that is implanted through the normal drainage angle (called the trabecular meshwork) of the eye, usually at the time of cataract surgery. This device has been proven in clinical trials to be both very safe and effective in lowering eye pressure in mild to moderate glaucoma. The iStent inject is the smallest implantable medical device approved for use in humans. All patients with glaucoma who are considering cataract surgery should be informed about the option of MIGS devices. This is a fantastic opportunity to not only treat their cataract but also treating their glaucoma, thereby potentially providing better eye pressure control and reducing or even eliminating their need for glaucoma eye drop medications.