Minimally Invasive Glaucoma Surgery (MIGS)

What is minimally invasive glaucoma surgery?

Minimally invasive glaucoma surgery (also called MIGS) refers to a group of newer glaucoma procedures that are much less invasive than traditional glaucoma surgery. They work by enhancing outflow of fluid on the inside of the eye and thereby reducing eye pressure. They can be done at the same time as cataract surgery and generally add just a few minutes to the overall procedure time.

MIGS procedures generally cause much less scarring with fewer complications than traditional glaucoma surgery. While MIGS generally reduce pressure less effectively than traditional glaucoma surgery, and have a somewhat higher failure rate, they are a good option for milder glaucoma. MIGS procedures can reduce the number of medications needed to control glaucoma and may reduce the likelihood that more invasive surgery will be needed in the future.

As cataract surgery patients are already going to the operating room, we typically offer the option of a MIGS procedure at the same time if they also have glaucoma.

What is the iStent inject® procedure?

iStent inject® includes two tiny implants, which make up the world’s smallest medical device implanted in the human body. iStent inject® is the next generation of iStent® — the first FDA approved Micro-Invasive Glaucoma Surgery (MIGS) device. Implanted during cataract surgery, iStent inject® can effectively lower IOP, one of the most important risk factors for glaucoma related vision loss, and may reduce reliance on glaucoma medication and improve glaucoma control.

What does the iStent inject^® do?

The iStent inject^®   device lowers eye pressure. It allows fluid to flow more easily out of the eye into the natural collection channels that normally drain fluid away from the inside of the eye. The iStent is implanted in the drain of the eye, and creates a pathway that bypasses the part of the drain that is most resistant to fluid outflow. This assists in maintaining eye pressure at a normal level.

Am I a good candidate for the iStent inject^® procedure?

The iStent inject^® is designed for patients who have mild or moderate glaucoma, with pressure that is fairly well controlled. It is currently approved for use in patients only at the time of cataract surgery. It is appropriate for open angle glaucoma (not narrow angle glaucoma), and does not lower pressure enough to treat advanced or poorly controlled glaucoma. The benefits of the iStent inject^® are its very low risk, better control of glaucoma, and minimal scarring. If pressure is well controlled, the patient is less likely to need additional drops or treatments for glaucoma.

Kahook Dual Blade® Procedure For Excisional Goniotomy

The Kahook dual blade goniotomy procedure is an additional MIGS procedure offered by our practice.

The trabecular meshwork (TM) is the drainage structure in the eye that drains fluid out of the inside of the eye. If the TM works well, excessive pressure does not build up in the eye. The TM is made up of hundreds of little channels that run circumferentially inside the eye at the outer edge of the iris (colored part of the eye). If these little channels become blocked or narrowed, fluid does not drain out properly and pressure can build up in the eye causing glaucoma.

A goniotomy is a procedure where the surgeon excises (cuts out) a portion of the diseased TM in order to increase outflow of fluid from inside the eye to lower intraocular pressure. This can be done using a surgical instrument called the Kahook Dual Blade®. This specially designed blade can precisely target the TM without damaging other eye structures. The procedure is done in the operating room and adds about 5 minutes to surgical time if the patient is already undergoing cataract surgery.