Our Summary

This research paper discusses Micro- or Minimally Invasive Glaucoma Surgeries (MIGS), a new development in the treatment of glaucoma. Glaucoma is an eye disease where the pressure inside the eye increases, damaging the optic nerve and causing vision loss. MIGS is not a single surgery but a group of different procedures and devices designed to lower eye pressure.

There are three main types of MIGS: those that improve the flow of fluid through the trabecular meshwork (the drainage system in the eye), such as Trabectome, iStent, Hydrus microstent, Kahook Dual Blade and gonioscopy-assisted transluminal trabeculotomy; those that increase the flow of fluid above the choroid (a layer of the eye), like Cypass microstent and iStent Supra; and those that form a bubble or bleb in the conjunctiva (the clear tissue covering the white part of the eye), such as Xen gel stent and InnFocus microshunt.

Compared to traditional glaucoma surgeries, like trabeculectomy and glaucoma drainage device implantation, MIGS are believed to have less severe complications and take less time to perform. However, as this field is still developing, the effectiveness and potential complications of each MIGS procedure should be evaluated separately. The paper emphasizes the importance of high-quality, long-term studies.

FAQs

  1. What is Micro- or Minimally Invasive Glaucoma Surgeries (MIGS)?
  2. How does MIGS compare to traditional glaucoma surgeries in terms of complications and surgical time?
  3. What are some examples of surgeries that fall under the MIGS category?

Doctor’s Tip

One helpful tip a doctor might tell a patient about glaucoma surgery is to make sure to follow all post-operative instructions carefully, including using any prescribed eye drops or medications as directed, attending follow-up appointments, and avoiding activities that could increase eye pressure, such as heavy lifting or straining. It is important to communicate with your doctor about any concerns or changes in your vision, as early detection and treatment of complications are crucial for a successful outcome.

Suitable For

Glaucoma surgery is typically recommended for patients who have not achieved adequate intraocular pressure control with medications or laser treatments. Patients with primary open-angle glaucoma, pseudoexfoliative glaucoma, and pigmentary glaucoma are often candidates for glaucoma surgery. Additionally, patients with narrow angles or angle-closure glaucoma may benefit from certain types of glaucoma surgery. It is important for patients to discuss their individual circumstances with their ophthalmologist to determine if glaucoma surgery is the best treatment option for them.

Timeline

Before glaucoma surgery:

  1. Patient is diagnosed with glaucoma through a comprehensive eye exam.
  2. Patient undergoes various treatments such as eye drops, laser therapy, or oral medications to manage intraocular pressure.
  3. If these treatments are not effective, the patient may be recommended for glaucoma surgery.
  4. Patient meets with their ophthalmologist to discuss the different surgical options available, including micro- or minimally invasive glaucoma surgeries (MIGS).
  5. Patient undergoes pre-operative testing to assess their overall eye health and determine the best surgical approach.

After glaucoma surgery:

  1. Patient undergoes the MIGS procedure, which is typically performed as an outpatient surgery under local anesthesia.
  2. Patient may experience some discomfort, redness, or blurry vision in the days following surgery.
  3. Patient is prescribed eye drops or other medications to help with healing and manage intraocular pressure.
  4. Patient attends follow-up appointments with their ophthalmologist to monitor their progress and ensure proper healing.
  5. Patient may experience improved vision and decreased intraocular pressure in the weeks and months following surgery.
  6. Patient continues to follow up with their ophthalmologist regularly to monitor their glaucoma and overall eye health.

What to Ask Your Doctor

  1. What are the specific benefits of undergoing MIGS for my glaucoma compared to traditional surgeries?
  2. What is the success rate of the MIGS procedure you are recommending for me?
  3. What are the potential risks and complications associated with the MIGS procedure?
  4. How long is the recovery time after MIGS surgery, and what can I expect during the recovery process?
  5. Will I still need to use glaucoma medications after undergoing MIGS surgery?
  6. How often will I need follow-up appointments after MIGS surgery to monitor my eye pressure and overall eye health?
  7. Are there any lifestyle changes or precautions I should take after undergoing MIGS surgery to ensure the best outcome?
  8. Are there any specific factors about my eye health or medical history that may impact the success of MIGS surgery for me?
  9. How experienced are you in performing MIGS procedures, and what is your success rate with this type of surgery?
  10. Are there any alternative treatment options for my glaucoma that I should consider before moving forward with MIGS surgery?

Reference

Authors: Mathew DJ, Buys YM. Journal: Annu Rev Vis Sci. 2020 Sep 15;6:47-89. doi: 10.1146/annurev-vision-121219-081737. PMID: 32936738