Nuttamon Srisamran
Thammasat University, Thailand
Title: Minimally Invasive Glaucoma Surgery (MIGS): Less is More.
Biography
Biography: Nuttamon Srisamran
Abstract
Trabeculectomy and glaucoma drainage device implantation are traditional surgeries and most commonly performed for glaucoma treatment, however, they carry the high rate of many complications and can lead to failure.
Minimally Invasive Glaucoma Surgery (MIGS) is a term which was coined in 2009 by Iqbal Ike Ahmed, MD, and describes a new group of implants, devices or surgical techniques that are less invasive and have lower risks than those of previously established procedures. All MIGS procedures share a number of common characteristics (ab interno microincision, minimal trauma, efficacy, high safety profile, and rapid recovery)1 and have four main mechanisms of IOP reduction as follows:2
1. Increasing trabecular outflow by bypassing juxtacanalicular trabecular meshwork
2. Increasing uveoscleral outflow via suprachoroidal pathways
3. Reducing aqueous production from ciliary body
4. Creating subconjunctival drainage pathway
These new alternative options are mainly indicated for patients with mild to moderate open angle glaucoma and
modest targeted IOP reductions. MIGS are frequently combined with cataract surgery and currently be the most common indication for surgery. Avoiding conjunctival dissection can preserve the tissue and suits for the future invasive surgeries.
MIGS can help minimize the number of medications, reduce the high cost of glaucoma treatment, and increase quality of life. Some MIGS had already been approved by US FDA eg. Trabectome, iStent, Kahook Dual Blade, Cypass, and XEN. And some are still under investigations eg. InnFocus, Hydrus, iStent inject, and iStent supra.3-7