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 no cure for glaucoma, MIGS helps lower eye pressure to prevent optic nerve damage and loss of vision.
Benefits of Minimally Invasive Glaucoma Surgery
Glaucoma patients have a variety of treatment options, and your eye doctor will work with you to develop a glaucoma management strategy that fits your medical history and lifestyle. For many, a MIGS procedure can be more effective than other glaucoma treatments and less invasive than standard glaucoma surgery.
MIGS has a shorter recovery time for patients with mild to moderate glaucoma and leads to fewer complications than traditional surgical methods. It’s also a viable choice for those who want to lessen their daily reliance on eye drops and medication.
Types of MIGS
A microtrabeculectomy is a procedure that places microscopic tubes into the eye to drain fluid from inside the eye to under the conjunctiva. There are two devices that are most frequently used, the Xen Gel Stent and the PRESERFLO Microshunt (previously known as INNFocus). These devices have been shown to be safe and can allow for more effective lowering of eye pressure than traditional trabeculectomy surgery.
The trabecular meshwork is the source of the majority of the obstruction to fluid drainage from the eye. Several procedures have been designed to cut through the trabecular meshwork without injuring any other tissues in the ocular drainage pathway, utilizing microscopic equipment and devices.
Trabecular surgery can either be performed to cut a microscopic-sized hole in the meshwork (Trabectome or Trab360), or a tiny snorkel-shaped device can be surgically implanted through a tiny incision into the trabecular meshwork under high-power microscopic eye surgery (iStent). This tiny snorkel-like device provides a channel for the fluid to drain and bypass the faulty trabecular meshwork.
These procedures are FDA approved but produce a limited reduction in eye pressure, so are best utilized for early to moderate stages of glaucoma.
To promote fluid drainage from the eye, small tubes are implanted to connect the front of the eye to the suprachoroidal space, which is the area between the retina and the outer wall of the eye. The fluid then drains away, reducing the eye pressure. This method is successful at lowering ocular pressure in moderately severe cases of glaucoma and has a low rate of serious complications.
Laser glaucoma surgery is primarily used for advanced glaucoma that is not controlled despite previous attempts with either of the trabeculectomy procedures above. Laser glaucoma surgery is designed to reduce the fluid inside the eye by targeting a part of the eye, known as the ciliary body, that produces the fluid. However, laser glaucoma surgery sometimes results in severe inflammation that could reduce vision.
Endocyclophotocoagulation and micropulse cyclophotocoagulation are two new laser treatments for glaucoma. These procedures also help with advanced stages of glaucoma by reducing the eye’s ability to create fluid. Decreasing the volume of fluid that’s produced reduces high eye pressure.
What To Expect From Minimally Invasive Glaucoma Surgery (MIGS)
Preparing for MIGS
Several diagnostic tests will be performed to determine if a MIGS procedure is right for you. These tests will also help your eye doctor decide which device or technique will best meet your needs. Once your MIGS procedure is scheduled, your eye doctor will provide detailed pre-procedure guidelines, which may include adding or discontinuing certain eye drops from your medication routine. Make sure you arrange for someone to drive you to and from your surgery.
The MIGS Procedure
MIGS is an outpatient procedure. Typically, you’ll receive local anesthesia or numbing eye drops, along with IV sedation supplied by an anesthesiologist. Many MIGS procedures are designed to be used in conjunction with cataract surgery, which means that the same incision used to remove your cataract will also be used to place 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 recovery time is reduced compared to standard surgery, although you should still expect a recovery time of up to several weeks. Your eye doctor will set up a follow-up appointment for you and provide you with post-procedure instructions that may include lifestyle modifications such as limited or no driving at all, or instructions related to returning to work. After about 6-8 weeks most MIGS patients can expect an improvement in intraocular pressure.
Who is a Candidate for MIGS?
When deciding if you are a candidate for MIGS, your eye doctor will consider both your medical history and your current glaucoma management plan.
An ideal candidate for MIGS usually has early to moderate open-angle glaucoma and is already planning to have cataract surgery. However, there are MIGS options for patients who are not in need of cataract surgery. To determine if MIGS is right for you, schedule an appointment at Vision MD Eye Doctors in Glenn Dale. We are dedicated to providing you with personalized care.