Understanding Minimally Invasive Glaucoma Surgery (MIGS)

What is glaucoma?

Glaucoma is a series of progressive eye illnesses that affect the optic nerve. Left untreated, over time this can cause irreparable vision loss and blindness. Glaucoma often develops gradually and without noticeable symptoms in its early stages, making it very difficult to catch early. Although glaucoma can occur for several reasons, elevated intraocular pressure (IOP) is the most significant modifiable risk factor. IOP is the pressure generated by the aqueous humor, a clear fluid in the eye. Normally, this fluid is created and drained at a balanced rate, but in glaucoma patients, drainage becomes impaired, resulting in a buildup of fluid that increases IOP. Elevated IOP puts stress on the optic nerve and hinders blood flow.

 

Limitations of Other Glaucoma Treatments

• Eye drops: Need to be used every day and can cause discomfort and other side effects
• Laser procedures: Temporarily relieve IOP, so some patients ultimately require additional treatment or surgery
• Surgeries: Trabeculectomy or glaucoma drainage device implantation can achieve pressure reduction, but they have long recovery periods and a high risk of complications, making them a last resort

What Is MIGS?

• For minimally invasive glaucoma surgery (MIGS), microscopic  instruments are used to make small cuts in the eye that don’t hurt the tissues too much. This makes the procedures safer and faster to heal from.
• Many MIGS procedures can be performed during cataract surgery, so patients with both conditions can address both conditions simultaneously
• MIGS does not reduce IOP as dramatically as surgeries like trabeculectomy, so they are better for candidates with moderate glaucoma

How MIGS Works

MIGS lowers IOP by improving outflow of aqueous humor, which can be done in three pathways:

1. Enhancing Trabecular Outflow

Trabecular MIGS improves drainage through the eye’s natural pathway, which is through the trabecular meshwork, Schlemm’s canal, and the episcleral venous system. Devices like iStend, Hydrus Microstend, and Kahook Dual Blade can bypass portions of the trabecular meshwork, improving the eye’s existing drainage system to safely treat mild to moderate glaucoma.

2. Enhancing Suprachoroidal Outflow

Create an alternative route for aqueous humor to leave the eye and enter the suprachoroidal space, achieving greater reductions in IOP than trabecular MIGS. However, there are concerns regarding long-term safety and endothelial cell loss

3. Enhancing Subconjunctival Outflow

Similar to trabeculectomy, procedures like XEN Gel Stent and PRESERFLO MicroShunt create a limited flow path into a bleb under the conjunctiva. These procedures are less invasive than surgery and best for patients with more severe glaucoma due to greater IOP reductions. However, they require more post-op monitoring and management compared to trabecular-based MIGS.

Types of MIGS Procedures

Trabecular Meshwork-Based MIGS

iStent

How it works

• Tiny titanium stent placed through the trabecular meshwork into Schlemm’s canal
• Improves aqueous outflow through the natural drainage system

Best candidates

• Mild open-angle glaucoma
• Patients undergoing cataract surgery
• Patients needing modest IOP reduction

Advantages

• Excellent safety profile
• Minimal recovery time

Limitations

• Limited pressure reduction compared with filtering procedures

Hydrus Microstent

How it works

• Scaffolds and dilates a segment of Schlemm’s canal

Best candidates

• Mild to moderate primary open-angle glaucoma
• Cataract surgery patients seeking greater pressure reduction than iStent alone

Advantages

• Sustained IOP lowering
• Medication reduction

Kahook Dual Blade

How it works

• Removes a strip of trabecular meshwork

Best candidates

• Mild to moderate glaucoma
• Patients requiring more substantial outflow enhancement

OMNI Surgical System

How it works

• Combines canaloplasty and trabeculotomy
• Treats multiple points of resistance in the conventional outflow pathway

Best candidates

• Mild to moderate open-angle glaucoma
• Patients needing greater pressure reduction

Suprachoroidal MIGS

Suprachoroidal Stenting

How it works

• Directs aqueous humor into the suprachoroidal space

Best candidates

• Patients requiring greater IOP reduction than trabecular procedures may provide

Considerations

• Several devices have faced safety concerns, limiting widespread use

Subconjunctival MIGS

XEN Gel Stent

How it works

• Creates a controlled drainage channel from the anterior chamber to the subconjunctival space

Best candidates

• Moderate to severe glaucoma
• Patients requiring lower target pressures
• Patients inadequately controlled with medications or other MIGS

Advantages

• Greater pressure reduction than many angle-based MIGS

Limitations

• Higher risk of bleb-related complications
• More postoperative management

PRESERFLO MicroShunt

How it works

• Establishes a permanent drainage pathway beneath the conjunctiva

Best candidates

• Moderate to advanced glaucoma
• Patients needing substantial IOP lowering

When Should a Patient Consider Each Type of MIGS?

Patient Situation		Most Appropriate MIGS
Mild glaucoma with cataract surgery		iStent, Hydrus
Mild-to-moderate glaucoma wanting fewer medications		iStent, Hydrus, Kahook Dual Blade
Moderate glaucoma requiring greater pressure reduction		OMNI, Kahook Dual Blade
Need for lower target IOP than angle-based MIGS can achieve		XEN Gel Stent
Moderate-to-severe glaucoma not controlled by medications		XEN Gel Stent, PRESERFLO MicroShunt
Advanced glaucoma requiring very low pressures		Traditional trabeculectomy or tube shunt may still be preferred

Limitations of MIGS

MIGS is generally less effective at lowering IOP than trabeculectomy and is not appropriate for every glaucoma subtype. Additionally, some patients still require medications after surgery

 

Why Choose Texoma Retina & Glaucoma for Minimally Invasive Glaucoma Surgery in Sherman, TX?

Texoma Retina & Glaucoma offers minimally invasive glaucoma surgery in Sherman, TX. They offer full glaucoma care using the most up-to-date diagnostic tools and cutting-edge surgery methods. People in Sherman, Denison, McKinney, Allen, and other North Texas cities trust our team to make custom treatment plans that help lower eye pressure and protect long-term vision. Our specialists are dedicated to providing excellent care close to home, whether you need a full glaucoma eye exam, an early diagnosis of glaucoma that damages the optic nerve, or advanced glaucoma treatment in North Texas.

 

Expert Glaucoma Specialist in Texas for Personalized Open Angle Glaucoma Treatment

The experts at Texoma Retina & Glaucoma, Dr. Vijay Khetpal and Dr. Rupak Dhoot, can diagnose and treat a wide range of glaucoma problems. They carefully check the eye health of each patient to see if drugs, laser therapy, open angle glaucoma treatment, or minimally invasive glaucoma surgery in Sherman, TX, is the best choice. Their goal is to stop the disease from getting worse, protect the optic nerve, and lower the risk of losing vision permanently by giving fast, evidence-based care. Patients get personalized care from glaucoma specialists in Texas who are known for their trustworthiness.

 

Protect Your Vision with Advanced Glaucoma Care in Sherman, TX

As a result, glaucoma often develops without any visible symptoms, damaging the optic nerve in a way that can’t be fixed. The best way to keep your eyes healthy is to get regular checkups and get help early on. Make an appointment at Texoma Retina & Glaucoma for a full glaucoma eye exam if you have been diagnosed with glaucoma or are more likely to get it because of your age, a family history of it, diabetes, or high eye pressure. Dr. Vijay Khetpal and Dr. Rupak Dhoot can help you protect your vision for the future by finding glaucoma early and treating it with advanced techniques. They also offer cutting-edge minimally invasive glaucoma surgery in Sherman, TX.

 

Conclusion

Minimally invasive glaucoma surgery offers safer options earlier compared to traditional surgery, improving it for patients with mild to moderate glaucoma. The optimal procedure depends on disease severity, target IOP, and medication burden. For patients with mild-to-moderate glaucoma, angle-based MIGS procedures are often ideal, while subconjunctival MIGS may be better suited for those requiring more substantial pressure reduction.