Minimally Invasive Glaucoma Surgery (MIGS)

Glaucoma is elevated fluid pressure within the eye. The various forms all tend to result from the blockage of the natural drainage channels inside the eye, hence most surgical treatments involve the creation of new drainage routes to relieve the pressure.

Trabulectomies and shunts like the Ahmed and Baerveldt types have been something of a gold standard approach to severe glaucoma. Reliable and highly effective, they are still not minor procedures for those who have to go through them and each has a number of associated complications.

The goal of all glaucoma surgery is to lower eye pressure to prevent or reduce damage to the optic nerve.

The MIGS group of operations have been developed in recent years in an attempt to minimise the physical aspects of surgery and in doing so reduce some of the complications of most standard glaucoma surgeries.

MIGS procedures utilise microscopic-sized equipment and tiny incisions. The procedures can be undertaken in minutes using specialised devices and the patient experience is much improbed. BUT, and there is always a but, whilst they reduce the incidence of complications, some degree of effectiveness is also traded for the increased safety.

The MIGS group of operations are divided into several categories:

• Miniaturized versions of trabeculectomy
• Trabecular bypass operations
• Totally internal or suprachoroidal shunts
• Milder, gentler versions of laser photocoagulation

Microshunts

Using tiny, microscopic-sized tubes that can be inserted into the eye and drain fluid from inside the eye to underneath the outer membrane of the eye (conjunctiva), new devices have been created to help make the trabeculectomy operation safer. The PRESERFLO Microshunt have shown excellent pressure lowering with improved safety over trabeculectomy in studies and has superseded the older XEN gel implant. The PRESERFLO is offered here at the Hampshire Eye Clinic.

Trabecular Bypass Surgery

Most of the restriction to fluid drainage from the eye rests in the trabecular meshwork. Several operations have been devised using tiny equipment and devices to cut through the trabecular meshwork without damaging any other tissues in the ocular drainage pathway. 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. The trabecular meshwork can either be destroyed (Trabectome or Trab360) or bypassed using a tiny trabecular bypass device (the iStent and Hydrus). These procedures are FDA-approved but generally don’t get the eye pressure very low so are most useful in early to moderate stages of glaucoma or in combination with cataract surgery. We are happy to advise you on the suitability of these devices to help control your Glaucoma.

Hydrus microshunt

iStent delivery device