LEARNING OBJECTIVES

A comprehensive overview of the current techniques in MIGS, including the coverage of the theory behind the techniques, discussion of relevant data on efficacy and safety.

Special Focus:

Minimally Invasive Glaucoma Surgery

Author: Michael Stone, MD, Iqbal Ike K Ahmed, MD

Departmentof Ophthalmology, University of Toronto, Toronto, Canada

Core concepts

• MIGS procedures are highlighted by their enhanced safety, enabling their usage earlier in the treatment paradigm and conducive to combining with cataract surgery.
• Schlemm’s canal MIGS procedures have the highest safety profile of all glaucoma surgeries, but are limited by episcleral venous resistance and downstream resistance.
• Suprachoroidal MIGS devices are designed to provide a more controlled cleft procedure, with potentially significant lowering dependent on the size of the suprachoroidal lake.
• Subconjunctival MIGS devices produce external filtering blebs and approach IOP targets similar to trabeculectomy (trab) with a safer and more controlled procedure.
• Selection of MIGS procedures is dependent on benefit-to-risk ratio, as well as intraoperative and postoperative intensity, cost-benefit, and reimbursement.