Minimally Invasive Glaucoma Surgery (MIGS)

The eye has multiple chambers, and each one is filled with different fluid. In the anterior chamber of the eye, the aqueous fluid is in constant exchange, circulating in and out. But sometimes there’s an obstruction or an inadequate output, and the intraocular pressure starts to rise. This may happen in glaucoma, for example.
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Minimally Invasive Glaucoma Surgery, or MIGS, is a modern procedure that increases patient safety and reduces considerably the chance of adverse events.
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General Categories of Minimally Invasive Glaucoma Surgery

MIGS can be divided into several types. According to the therapeutic approach, we can divide them into the following categories:

MIGS that improve the natural outflow: These procedures use the natural drainage system of the anterior chamber of the eye. They enhance the outflow by solving the obstruction that blocks the normal circulation of aqueous fluid. iStent, GATT, Trabectome, and Kahook Dual Blade Goniotomy are examples under this category.

MIGS that shunt fluid out of the eye: These procedures use an artificial draining system through a shunt that is installed in the anterior chamber to take out excess fluid. An example procedure is XEN Gel Stent.

MIGS that decrease the aqueous fluid production: Through these procedures, the drainage system is left as it is, and we focus on reducing the production of aqueous fluid instead. An example procedure is ECP.

MIGS that implant medication inside the anterior chamber: The goal here is to reduce or eliminate the need for drops. An example of this would be Durysta.

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What happens during MIGS?

There are different procedures, each one with an application and special techniques. Here’s a brief summary of the most important:

iStent: In this procedure, a device will be implanted in the natural draining system of the anterior chamber. This device is designed to enhance the outflow of aqueous liquid.

GATT: Also known as Gonioscopy-Assisted Transluminal Trabeculotomy, it is a procedure in which the natural draining system is bypassed with an iTrack microcatheter. It is a suitable surgery for pediatric patients with glaucoma.

Trabectome: After introducing a trabectome tip through the cornea, excess tissue that blocks liquid outflow is ablated through heat.

Kahook Dual Blade Goniotomy: Similar to the above, the tip of the Kahook Dual Blade is inserted through the cornea. In this case, the procedure is meant to create an opening by removing excess tissue in the trabecular meshwork.

XEN Gel Stent: It’s a small device that is inserted and left into the eye to create a small channel that drains fluid out of the anterior chamber into the subconjunctival space (deep into the white portion of the eye).

ECP: Also known as Endoscopic Cyclophotocoagulation, it is a minimally-invasive procedure that uses laser energy to deliver heat and ablate the ciliary processes. By doing so, the production of liquid into the anterior chamber is reduced, and the intraocular pressure improves over time.

Durysta: During this procedure a tiny implant is inserted into the anterior chamber and the drug is slowly released during the following months.

These procedures can be performed on an outpatient basis, and reduce the need of more invasive techniques to reduce intraocular pressure. They also reduce the medication burden of glaucoma and intraocular hypertension without a long list of adverse events.