A discussion on MIGS most commonly used in clinical practice. An approach to differentiating mechanisms of action and discuss potential patient target populations.

Clinical Issues:

Microinvasive / Minimally invasive glaucoma surgery (MIGS)

Author: Ridia Lim MBBS MPH FRANZCO¹, Lawrence Oh B Med MD²

1 Sydney Eye Hospital, Sydney, Australia 2 Royal North Shore Hospital, Sydney, Australia

Core concepts

• The most commonly used MIGS are aimed to enhance Schlemm’s canal outflow including the Trabectome, iStent and Hydrus microstent. As intraocular pressure reduction is modest, these are useful for mild to moderate open angle glaucoma cases, particularly combined with cataract surgery.
• The newer gel stent, Xen increases subconjunctival filtration and acts like a trabeculectomy. Its target population may be different from canal-MIGS.