Alcon's decision and corresponding recommendation was based on an analysis of five-year post-surgery data from the COMPASS-XT long-term safety study. Two recent additions to the laser treatment procedures have proven useful even before the glaucoma is far advanced. This operation has relatively few serious complications and lowers pressures enough to be useful even in moderately severe glaucoma. Abstract Micro- or minimally invasive glaucoma surgeries (MIGS) have been the latest addition to the glaucoma surgical treatment paradigm. It is called MIGS, the acronym for minimally invasive glaucoma surgery, and it is the biggest development in glaucoma surgical treatment in many years. The procedure can be performed alone or in conjunction with cataract surgery. mission to educate glaucoma patients and speed a cure. During the last 25 years, glaucoma management has been based in the use of pharmaceutical therapies and incisional surgery. The surgery site can scar over time and the pressure can go back up. There are a few different types of surgery for glaucoma that can help lower the pressure in your eye: Trabeculectomy (“tra-BECK-yoo-LECK-toh-mee”) Glaucoma implant surgery. Medical and surgical management of glaucoma, cataract and diseases of the anterior segment, comprehensive ophthalmology, cataract surgery, combined cataract and glaucoma surgery, minimally-invasive glaucoma surgery, trabeculectomy, glaucoma drainage device surgery. [1][2] While MIGS procedures offer fewer side effects, the procedures tend to result in less intraocular pressure (IOP) lowering than with trabeculectomy or glaucoma tube shunt implantation. Last reviewed on These include Trabectome, iStent and CyPass Micro-Stent. [2], Traditional glaucoma surgery generally involves an external (ab externo) approach through the conjunctiva and sclera; however, MIGS procedures reach their surgical target from an internal (ab interno) route, typically through a self-sealing corneal incision. [4] Increased intraocular pressure (IOP) is the main and only modifiable risk factor, attributed to the progression of the disease. A Cochrane Review published in December 2019 did not find any published clinical trials to assess whether the InnFocus Microshunt is safer and more comfortable for patients than standard glaucoma surgery (trabeculectomy). Open angle glaucoma (OAG) is a disease affecting an estimated 2.8 million people in the United States as of 20101, accounting for an approximate cost of $1.5 billion per year.2 Initial therapy for OAG typically consists of medications that can aid in decreasing aqueous humor production or increasing aqueous humor outflow. (2018 update: See note below regarding the CyPass Micro-Stent). Dr Chelvin Sng (MBBChir, MA, FRCSEd) graduated from Cambridge University, UK, with triple first class honours and distinctions.She is amongst the first surgeons in Asia to be accredited in the use of several micro-invasive glaucoma surgery … Traditional glaucoma filtration surgeries, such as trabeculectomy and glaucoma drainage implants (GDI), have well-established efficacy in lowering intraocular pressure (IOP), but it comes at the cost of a very high rate of complications. While traditional glaucoma surgery involves making a large incision or placing a large tube in the eye to lower the pressure, Dr. Song thought she was a good candidate for a newer, minimally invasive … Free shipping . [20] Cyclodialysis cleft procedures were initially used to access this pathway with significant IOP lowering, but the cleft was prone to high anatomic variability as well as early postoperative closure due to the lack of a permanent drainage implant with a standardized and uniform conduit. Because minimally invasive glaucoma procedures are microscopic and use smaller incisions, they are much lower risk for complications and typically have a quicker return of vision and recovery. Using tiny tubes with very small internal openings, the front of the eye is connected to the suprachoroidal space between the retina and the wall of the eye (Glaukos shunts) to augment the drainage of fluid from the eye. Send this article to a friend by filling out the fields below: MIGS has become a commonly used abbreviation in the glaucoma world. Micro-invasive glaucoma surgery (MIGS) is the latest advance in surgical treatment for glaucoma, which aims to reduce intraocular pressure by either increasing outflow of aqueous humor or reducing its production. [15] Multiple studies have since confirmed the MIGS-type efficacy and safety profile of the iStent. This includes routine and complex cataract surgery as well as traditional and minimally invasive glaucoma surgery, including iStent, Kahook goniotomy, XenGel Stents, CPC/Micropulse, and ECP. Previously, laser cyclophotocoagulation was reserved for advanced glaucoma that could not be controlled despite trabeculectomy or tube shunts. (2019 update: These devices have recently been approved for use in the US). Minimally Invasive Glaucoma Surgery: A Practical Guide - Hardcover - VERY GOOD. May 2016 issue of Gleams. [17], A 2019 Cochrane Review found that individuals who receive iStents in combination with cataract surgery may be less likely than those who only receive cataract surgery to need glaucoma eye drops at medium-term follow-up; however, the evidence for this finding was of low quality. There are also newer procedures known as minimally invasive glaucoma surgery (MIGS) that hold promise at treating glaucoma. [33] Unlike the latter two procedures, the XEN Gel Stent is performed through an internal approach and avoids directly incising and disrupting the conjunctiva itself.[34][35]. [30] The Hydrus Microstent is the longest of the MIGS devices (8-millimeter long implant), and similar to the iStent it is designed to increase trabecular outflow. No. [21], It has a microlumen of 300 microns and is designed to augment outflow to the suprachoroidal space in order to control intraocular pressure; it is indicated for the treatment of primary open-angle glaucoma. Minimally invasive glaucoma surgery (MIGS) has become a reliable standard of care for the treatment of glaucoma when combined with cataract surgery. [11][12] Safety of the iStent was comparable to cataract surgery alone which is much better than conventional trabeculectomy. Using a special contact lens on the eye, a tiny device is inserted into the eye through a tiny incision into the trabecular meshwork under high power microscopic control. Subspecialty: Glaucoma… Stay up-to-date with the latest news about glaucoma, treatments, and research. Micro-Invasive Glaucoma Surgery. Standard glaucoma surgeries, trabeculectomy and external tube-shunts are major and sometimes necessary surgeries. New developments in Micro-Invasive Glaucoma Surgery (MIGS) allow patients to have glaucoma and cataract surgery during one procedure, and most patients with a cataract and open-angle glaucoma … Offer more modest results than traditional glaucoma surgery, but with the benefit of a safer risk profile. It includes different types of implants, stents or procedures used in conjunction with or without cataract surgery to help lower the pressure of the eye for patients with mild to moderate glaucoma. The techniques minimize tissue scarring, allowing for the possibility of traditional glaucoma procedures such as trabeculectomy or glaucoma valve implantation (also known as glaucoma drainage device) to be performed in the future if needed. These devices (the Xen Gel Stent and PRESERFLO [formerly InnFocus] Microshunt) have shown excellent pressure lowering with improved safety over trabeculectomy in studies done outside the United States. Standard glaucoma surgeries — trabeculectomy and ExPRESS shunts, external tube-shunts like the Ahmed and Baerveldt styles — are major surgeries. These procedures may be discussed in a future article. The destruction of these ciliary processes with a diode laser, known as cyclophotocoagulation, can be used to decrease the amount of aqueous humor produced, thereby reducing the intraocular pressure. When these two options are no longer sufficient or are not suitable, … What are MIGS? [44], Trabectome is unique among the MIGS procedures, as there is no physical device implanted inside the eye; the pressure lowering is a direct result from the destruction and removal of the trabecular meshwork. $10.73. [1][2][3] Studies have shown that the iStent is an effective procedure, typically lowering intraocular pressure to the mid-teens. [32] The Hydrus Microstent is currently being investigated in an FDA approved study for mild-to-moderate glaucoma. Update on CyPass Micro-Stent: On August 29, 2018, Alcon announced an immediate, voluntary market withdrawal of the CyPass Micro-Stent from the global market and advised surgeons to immediately cease further implantation with the CyPass Micro-Stent. The first clinical data on the device was presented in 2010 showed sustained IOP lowering and MIGS-like safety profile. [11][12][13][14] Common complications include failure to implant the device, touching the iris with the device, and touching the undersurface of the cornea (endothelium) with the device. In this advanced glaucoma eye surgery, … Glaucoma is a disease that occurs when pressure from fluid buildup damages the optic nerve. [1] MIGS procedures involve a minimally invasive approach, often with small cuts or micro-incisions through the cornea that causes the least amount of trauma to surrounding scleral and conjunctival tissues. Minimally Invasive Glaucoma Surgery (MIGS) MIGS (Minimally Invasive Glaucoma Surgery) is another type of treatment for open-angle glaucoma. Increase; Decrease; Normal; Current Size: 100%. [19], The CyPass Micro-Stent is the first MIGS device developed for lowering of IOP through the suprachoroidal space (virtual space between the choroid and sclera created by implantation of the device), a part of the uveoscleral outflow pathway for aqueous humor. Studies have found a decrease in intraocular pressure to the mid-teens following the procedure, which has a favorable safety profile. It stands for minimally invasive glaucoma surgery. [6][23][24][26] Data from a large randomized controlled pivotal study (The COMPASS Clinical Study) has reported positive efficacy after 2 years of follow-up and will be submitted to FDA for approval. The implant is inserted through the trabecular meshwork, thus bypassing resistance of aqueous flow through the tissue. [41] A Cochrane Review published in 2019 found no relevant published studies on endoscopic cyclophotocoagulation to assess its effectiveness compared to other surgical treatments (including other MIGS), laser treatment or medical treatment. However, other glaucoma surgeries, such as canaloplasty, have shown that mechanical dilation of Schlemm’s Canal is also associated with a reduction in intraocular pressure. While they reduce the incidence of complications, some degree of effectiveness is also traded for the increased safety. Shields' Textbook of Glaucoma… We appreciate support from corporations who believe in our The rate of reoperation for complications was 22% in the tube group and 18% in the trabeculectomy group. Sponsor opinions are not reflected on our website. [38][39] Recent advances have now allowed a diode laser to be combined with a camera (endoscope) allowing for direct visualization of the ciliary processes during the ablation (Endo Optiks, Beaver Visitec, Waltham, MA). [46], National Institute for Health and Care Excellence (NICE), "Micro-invasive glaucoma surgery: current perspectives and future directions", "Update on Minimally Invasive Glaucoma Surgery (MIGS) and New Implants", "Definition of glaucoma: clinical and experimental concepts", "Phacoemulsification versus phacoemulsification with micro-bypass stent implantation in primary open-angle glaucoma: randomized double-masked clinical trial", "Cataract surgery with trabecular micro-bypass stent implantation in patients with mild-to-moderate open-angle glaucoma and cataract: two-year follow-up", "Surgical complications in the Tube Versus Trabeculectomy Study during the first year of follow-up", "Postoperative complications in the Tube Versus Trabeculectomy (TVT) study during five years of follow-up", "A review of the iStent(®) trabecular micro-bypass stent: safety and efficacy", "Ab interno trabecular bypass surgery with iStent for open-angle glaucoma", "Trabecular stent bypass microsurgery for open angle glaucoma | Guidance | NICE", "Minimally Invasive Ab-Interno Suprachoroidal Device (CyPass) for IOP Control in Open-angle Glaucoma - Transcend Medical", "Transcend Medical touts data, plans FDA filing for CyPass glaucoma stent – MassDevice", "Startup Transcend to submit PMA in second half for glaucoma micro-stent after positive pivotal data", "Alcon announces voluntary global market withdrawal of CyPass Micro-Stent for surgical glaucoma", "Improvement in outflow facility by two novel microinvasive glaucoma surgery implants", "Subconjunctival draining minimally-invasive glaucoma devices for medically uncontrolled glaucoma", "EyeWorld | PreserFlo: The device formerly known as the InnFocus Microshunt", "Endoscopic cyclophotocoagulation (ECP) for open angle glaucoma and primary angle closure", "Trabectome (trabeculectomy-internal approach): additional experience and extended follow-up", "Trabectome surgery for primary and secondary open angle glaucomas", https://en.wikipedia.org/w/index.php?title=Minimally_invasive_glaucoma_surgery&oldid=985313014, Articles with unsourced statements from September 2018, Creative Commons Attribution-ShareAlike License, This page was last edited on 25 October 2020, at 07:00. The ciliary body contains 72 protrusions known as ciliary processes, from which the aqueous is produced. [43] The Trabectome uses electrocautery via an internal approach to vaporize the trabecular meshwork, creating a large pathway for aqueous to flow, with minimal trauma to surrounding tissues. The uveoscleral pathway is an important pathway for aqueous outflow and drainage which can account for up to 57% of total outflow. [5] MIGS procedures can provide the patient sustained IOP reduction while minimizing the risk and complications associated with glaucoma interventions and decrease the dependence of glaucoma medications. These are endocyclophotocoagulation and micropulse cyclophotocoagulation. While they are very often effective at lowering eye pressure and preventing progression of glaucoma… The goal of all glaucoma surgery is to lower eye pressure to prevent or reduce … Yes [40], Endocyclophotocoagulation is indicated for the treatment of both open and closed angle glaucoma and is performed in eyes which have already undergone cataract surgery or performed concomitantly with cataract removal. Minimally invasive glaucoma surgery (MIGS) devices can be are employed in any glaucoma surgery that avoids conjunctival dissection, and includes an ab interno incision for the treatment of patients … At five years, the CyPass Micro-Stent group experienced statistically significant endothelial cell loss compared to the group who underwent cataract surgery alone. The trabecular meshwork can either be destroyed (Trabectome or Trab360) or bypassed using a tiny snorkel-like device (the iStent). MIGS has become a commonly used abbreviation in the glaucoma world. [36], The InnFocus Microshunt has now been renamed the Preserflo.[37]. By performing the procedure from an internal approach, MIGS procedures often reduce discomfort and lead to more rapid recovery periods. Minimally Invasive Glaucoma Surgery A Safer, Less Invasive Solution. Reported adverse reactions include intraocular inflammation, bleeding, and cystoid macular edema (swelling of the retina). Minimally invasive glaucoma surgery (MIGS) is a treatment approach focused on lowering eye pressure in order to prevent or reduce harm to the optic nerve. [25] This has been substantiated in subsequent studies in the combined setting with cataract surgery and as a stand-alone treatment for patients failing glaucoma topical therapy. 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