ProceduresMinimally Invasive Glaucoma Surgery (MIGS)

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Last updated 10/7/2019
MIGS, minimally invasive glaucoma surgery, Assil Eye Institute Los Angeles

What’s Minimally Invasive Glaucoma Surgery (MIGS)?

MIGS is a state-of-the-art minimally invasive glaucoma surgery which uses microscopic instruments to facilitate small incision surgery. It provides a safer option to reduce eye pressure than conventional surgery, with the added benefits of a higher success rate and faster recovery time.

The goal of MIGS procedures is to improve fluid drainage out of the eye in patients with mild to moderate glaucoma, reducing elevated eye pressure that damages the optic nerve. Clinical trials have shown that MIGS procedures achieve a significant decrease in eye pressure over periods up to 24 months, along with a decrease in prescription eye drop usage.

 

MIGS procedures are frequently performed in combination with cataract surgery for the appropriate patients. MIGS performed at the Assil Eye Institute include iStent, OMNI 360, XEN gel stent, and Endocyclophotocoagulation.

The three types of MIGS

 

MIGS procedures fall into three different categories according to how they achieve decreased intraocular pressure:

  • Improving your eye's natural drainage system, known as the trabecular meshwork (iStent, Trabectome and OMNI360)
  • Redirecting excess ocular fluid outside of your eye (XEN Gel Stent)
  • Decreasing the production of ocular fluid within your eye (Endocyclophotocoagulation)

 

What are the surgical options for lowering eye pressure?

Procedures that decrease eye pressure by improving your eye's natural drainage system

iStent Trabecular Micro-Bypass Stent

The iStent is the smallest implantable device approved for use in the human body. It is a titanium device that is implanted at two different sites in the front of your eye to create two bypasses that increase ocular fluid outflow through your eye's natural drainage system. The iStent is typically implanted during the time of cataract surgery. In clinical trials of the next generation iStent Inject, the majority of patients were medication-free at 23 months. The stent is made of titanium, so you can safely undergo MRI studies without the risk associated with metal implants.

 

iTrack Canaloplasty

The iTrack repairs the eye's natural drainage system in two ways: First, it uses a micro-catheter to bore a path through the eye's clogged natural drainage canal (called Schlemm's canal). Next, once the canal has been cleared of debris, a viscoelastic gel is injected into the canal and expands, widening the canal diameter by two to three times its original size. The net result is greater fluid outflow and decreased eye pressure.

 

Trabectome

FDA approved in 2006, the Trabectome is an electrocautery device that removes part of the meshwork that is part of your eye's natural drainage system for excess ocular fluid. By creating a larger opening in the meshwork, this procedure enlarges your eye's natural outflow channel, thus decreasing internal eye pressure.

 

The Omni360 Glaucoma Treatment System

This system combines two MIGS procedures in one surgery. First, it creates a new internal channel for shunting fluid from within your eye and directing it out through your eye´s natural drainage system. Secondly, it enlarges the natural opening from your eye's drainage system to the primary canal through which fluid exits your eye (called Schlemm´s canal).

 

Procedure that redirects excess ocular fluid out of your eye

XEN Gel Stent

This is a stent device made of a soft gel material that is the size of an eyelash. It is placed through the eye wall without requiring an incision in the conjunctiva (the clear membrane covering the white of your eye). It is designed to stay in your eye permanently. The XEN stent is placed in the front of your eye to shunt excess ocular fluid from within your eye to a location just under the conjunctiva (the clear outer membrane over the white of your eye).

 

Procedure that decreases ocular fluid production

Endocyclophotocoagulation

Also known as ECP, Endocyclophotocoagulation utilizes a miniature camera placed inside the eye to view the cells that are producing ocular fluid (called ciliary body cells). These cells are then treated with a very precise laser beam to decrease their fluid production activity, thereby leading to lower intraocular pressure. ECP can be used for both open angle or closed angle glaucoma patients and takes about 5 minutes per eye.

 

Schedule your consultation 


Which glaucoma surgery is right for me?

During your examination, your eye doctor will review the options available from our large toolkit of procedures that will best address your individual needs as determined by a number of variables, including the type of glaucoma and stage of your disease, your eye anatomy and any concurrent medical conditions that you may have.

 

REFERENCES
1. Saheb H, Ahmed I. Micro-Invasive glaucoma surgery: current perspectives and future directions. Curr Opin Ophthalmol. 2012;23:96-104.

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