MIGS -Micro Incisional Glaucoma Surgery is revolutionizing glaucoma surgery. Glaucoma surgery used to require invasive large incision procedure requiring sutures, prone to scarring with variable results and long recovery. This is no longer the case there are several new surgical devices that can be implanted through small self sealing incisions. Some of these are only approved with cataract surgery in the USA. The Express shunt was the first device to enter this space. It is a small tube placed under the white vascular loose covering of the eye (Subconjunctival space) and though the withe part of the eye into the he filled area in the front of the eye (Anterior chamber). Although it is not truley a MIGS device bucause it still required sutures on the outside of the eye, it still began the change leading to the devices we have now. The next device was really the first MIGS device available in the USA, the Istent a very small tube device shaped like a capital letter L. This device is placed into the drainage canals of the eye (Schlemm’s canal) to allow fluid to bypass the poorly functioning natural pathway (Trabecular meshwork). While this works it has been found multiple devices are required to achieve good results and this is not approved by insurers in the USA. Most US surgeons are using other devices. The next device arrived last year, The Cypass Shunt takes the fluid a different route from the anterior chamber into the vascular space beneath the outer covering of the eye and above the retina (Suprachoridal space). This shunt is easy for surgeons to place and is all done through a small 1 mm incision during cataract surgery. The last device is the Xengel Stent it is a soft implant that shunts the fluid from the Anterior chamber to the subconjunctival space. This procedure can be done with cataract surgery or by itself. All the procedures are approved for open angle glaucoma of based on severity of the disease. Your surgeon will choose one based on the selection criterion provided by the manufacturer. There are several other new devices under development and close to FDA approval stay tuned for more info.
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