The key elements of minimally invasive glaucoma surgery

Revered consultant ophthalmologist Mr Hussameddin Muntasser explains all you need to know about minimally invasive glaucoma surgery (MIGS) including advantages, risks and the various types available.

When may minimally invasive glaucoma surgery be an option?

If you are currently using topical treatments to lower intraocular pressure due to glaucoma or ocular hypertension and are planning to undergo cataract surgery, a minimally invasive glaucoma surgery (MIGS) procedure may be an excellent option. It can help reduce your reliance on eye drops or potentially eliminate the need for them entirely.

What risks are linked to minimally invasive glaucoma surgery (MIGS)?

Minimally invasive glaucoma surgeries (MIGS) are designed to have a minimal risk profile. However, to ensure their safety and suitability for you, a comprehensive evaluation of your eye health is necessary. This includes assessing the severity of your glaucoma, determining whether your condition is stable or progressing, and evaluating if MIGS will provide adequate pressure control for your needs. Additionally, we will examine the drainage angle in your eye to confirm its suitability for a MIGS implant and assess the health of the cornea to ensure it will not be adversely affected by the procedure.

The primary goal of MIGS is to manage intraocular pressure without the need for eye drops. This can help control your condition while also reducing irritation often associated with prolonged use of topical treatments.

MIGS procedures are not expected to increase the typical risks associated with cataract surgery. However, they may cause slightly more blurred vision in the initial days following surgery compared to a standard cataract operation. The most significant risk associated with the MIGS devices I use is that the reduction in eye pressure may not be sufficient to achieve the desired target.

What are the various types of minimally invasive glaucoma surgery (MIGS) options?

There are many types of MIGS procedures. Many target the trabecular meshwork that helps to drain the aqueous humour fluid within the eye. Stents such as the iStent from GLAUKOS and Hydrus Microstent from Alcon provide a bypass route through this meshwork to aid in this drainage process.

Another class of MIGS include supra-ciliary space implants such as the Miniject from iStar Medical, which creates a whole new route for drainage of aqueous humour. OMNI and iTrack Advance help to reform the channels behind the trabecular meshwork, or even to remove this meshwork to remove the main site of resistance to the outflow facility in the eye.

iStent is the MIGS device that has been longest in use and has largest amount of data to support its use, and the Hydrus Microstent is shown to be effective in some of the largest studies in this field, I am happy to use both depending on the needs of the patient, their impact on recovery time is very minimal in fact.

Miniject is another option I offer at my clinic, as it provides a different route and is proven to be very effective. Some patients can experience blurred vision after the operation but this tends to resolve in few days or weeks.

What are the advantages of MIGS?

MIGS offers many advantages as patients recover faster and do not feel the discomfort and blurred vision that can be associated with traditional glaucoma surgery. In fact, its safety profile has meant that many patients who would previously would have required a significant glaucoma operation, such as trabeculectomy would achieve good pressure lowering without the risks associated with it. Additionally, in many cases, it can act as a bridge until the patient is ready for traditional glaucoma surgery.

What are the latest developments in MIGS?

This field holds great promise with future advancements. There are modern options such as implants that contain slow-release forms of medicines, usually found in eye drops, or implants that can be used without the need to combine them with cataract surgery.

You can book a consultation with Mr Muntasser via his Top Doctors profile today.