Minimally Invasive Glaucoma Surgeries (MIGS)
Exploring MIGS Options
Several surgical approaches fall under MIGS, each designed to enhance or create pathways for fluid drainage or reduce its production. The choice of technique depends on your eye anatomy, glaucoma severity, and treatment goals.
These tiny implants create a direct route for fluid to move from the trabecular meshwork into Schlemm’s canal.
- iStent and iStent Inject: Titanium microdevices that often reduce eye pressure by about 20 percent when combined with cataract surgery.
- Hydrus Microstent: A flexible nitinol stent that both bypasses the meshwork and keeps Schlemm’s canal open.
Instead of placing an implant, these methods remove portions of the meshwork to enlarge the drainage opening.
- Kahook Dual Blade (KDB) Goniotomy: Uses a dual blade to excise tissue and limit scarring.
- Trabectome: Employs electrocautery with irrigation and aspiration to remove a strip of meshwork.
- Gonioscopy Assisted Transluminal Trabeculotomy (GATT): Creates a 360-degree incision for a circumferential opening.
These techniques dilate Schlemm’s canal to improve natural outflow without significant tissue removal.
- VISCO360 or OMNI System: Combines viscodilation with trabeculotomy.
- Ab Interno Canaloplasty (ABiC): Uses a light-guided microcatheter for controlled viscodilation.
For certain patients, rerouting fluid outside the conventional pathway may be beneficial.
- XEN Gel Stent: Shunts fluid into the subconjunctival space and is helpful in refractory glaucoma.
- Suprachoroidal Approaches: Ongoing research explores safe ways to use the uveoscleral pathway.
Some MIGS procedures lower pressure by decreasing fluid production.
- Endocyclophotocoagulation (ECP): A laser probe treats the ciliary body to reduce fluid creation.
Understanding MIGS and Its Significance
Lowering eye pressure is the only proven way to slow glaucoma progression. MIGS provides an intermediate step for patients whose pressure remains high despite drops or laser therapy.
Uncontrolled pressure can damage the optic nerve and lead to irreversible vision loss, making timely intervention essential.
MIGS offers a safer option than traditional surgery for mild to moderate glaucoma, often reducing reliance on daily medications.
Defining the MIGS Procedure
MIGS is characterized by small incisions, minimal tissue disruption, and a high safety profile. Complication rates are lower than with older glaucoma surgeries.
Typical pressure reductions average around 20 percent, achieved through either improving outflow or decreasing fluid production.
Risks such as hypotony, hemorrhage, and infection are less common because MIGS preserves more of the eye’s natural anatomy.
Procedures are grouped by how they help the eye drain fluid or reduce its creation, letting specialists tailor care to each patient.
Who Benefits Most from MIGS
Careful evaluation of glaucoma severity, eye structure, and lifestyle helps determine if MIGS is a good fit.
MIGS is especially helpful for people who need a modest pressure drop and want to avoid complex surgery.
- Primary open-angle glaucoma with mild to moderate disease.
- Difficulty tolerating or adhering to long-term eye drops.
- Desire for a safer option than traditional incisional surgery.
Performing MIGS during cataract removal can address two problems in one procedure and improve overall visual health.
Advanced glaucoma may still require more aggressive operations to reach very low pressure targets.
How MIGS Works: Restoring the Eye’s Natural Drainage
MIGS techniques lower pressure by enhancing existing pathways or creating new ones, or by reducing fluid formation.
Bypass stents or tissue removal improve flow from the meshwork into Schlemm’s canal.
- Stents such as iStent or Hydrus form direct channels.
- Goniotomy or trabeculotomy removes obstructive tissue.
Dilation of the canal helps fluid move into the bloodstream more freely.
- Microcatheter dilation gently stretches the canal walls.
- Canaloplasty keeps the canal open with viscoelastic gel.
When natural routes are inadequate, alternate channels let fluid exit the eye.
- Subconjunctival drainage with devices like the XEN Gel Stent.
- Suprachoroidal drainage to tap the uveoscleral pathway.
ECP treats the ciliary body so the eye produces less aqueous humor, lowering pressure from within.
Benefits and Considerations of MIGS
MIGS offers many advantages, yet ongoing care remains vital because glaucoma is a lifelong condition.
Small incisions and limited tissue disruption lead to a gentler surgical experience.
Patients often return to normal activities sooner than after traditional glaucoma surgery.
Successful pressure control can decrease the need for daily eye drops.
Lower complication rates make MIGS appealing to both patients and surgeons.
Performing MIGS at the same time as cataract removal can maximize convenience and results.
Regular eye exams remain essential to monitor pressure and adjust treatment when needed.
Frequently Asked Questions
Below are answers to common questions we hear from our glaucoma patients.
No. MIGS uses tiny implants or surgical tools through small incisions, while laser procedures like selective laser trabeculoplasty use focused light to improve drainage without implants.
MIGS does not cure glaucoma. It slows disease progression by lowering eye pressure, and lifelong monitoring is still required.
Many patients enjoy significant pressure reduction for years, though results vary. Regular follow-up ensures the procedure continues to meet your needs.
You will have scheduled visits to check pressure, watch for complications, and adjust medications. Some patients reduce or stop drops, while others use fewer or lower-dose medicines.
Patients with mild to moderate open-angle glaucoma who have not achieved desired pressure control with medications, or who are planning cataract surgery, are often good candidates.
Trusted Care for Minimally Invasive Glaucoma Surgeries
Our team is dedicated to offering safe, effective MIGS options that fit your unique situation. We look forward to guiding you through every step of your glaucoma care and helping you protect your vision for years to come.
Clean and comfortable reception area as well as testing and exam room. Dr Feng and Dr Garg were very helpful in providing clear and accurate and reliable information on my eye condition and the treatments moving forward as well as thoroughly explaining every procedure. I could not be in better hands in my opinion. The extent and care from Doctor Garg were exceptional!!
Lynda Paradiso
My eyes are more of a cause of panic for me. The Ophthalmologists and clinical/service teams are great. They have in office Optometrists to address your eye wear or contact needs.
Stephen Sottile
Advanced Eye Care Randolph, NJ is fantastic. Dr. Feng and Dr. Reing combined expertise to make my pre and post surgery a success. Dr. Feng is also an excellent surgeon. I am eternally grateful.
Bev D
Excellent team! Dr. Feng and Michelle were kind and Knowledgeable. I felt comfortable and confident about the care provided
Shaquille Brown
Advanced Eye Care is the #1 place to go for all you eye care needs. The doctors and all their staff are friendly and helpful.
Claire & Jack