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Minimally Invasive Glaucoma Surgery (MIGS) refers to a group of procedures that are performed relatively quickly with little manipulation to the eye, usually under topical (eye drop) anesthesia, using small incisions and no sutures. The goal of a MIGS procedure is to provide rapid recovery while minimizing the risks associated with conventional glaucoma surgery.
As a general rule, the less invasive a procedure, the less likely it is to achieve a significant change in the eye pressure or continue to function long-term. Therefore, there is a trade-off between the degree of safety and the effectiveness of the procedure.
Some MIGS procedures (such as the iStent and Hydrus) are reserved for more mild types of glaucoma that are being treated at an early stage. Other MIGS procedures (such as the XEN stent) can be performed on more advanced glaucomas.
The XEN Gel Microstent is a very small glaucoma implant designed to reduce intraocular pressure in difficult to control glaucoma cases. It is placed using a fine delivery injector. It creates a channel that connects the anterior chamber to the subconjunctival space, allowing aqueous humor to flow into a small reservoir called a bleb. The fluid is then absorbed into the blood stream around the eye. The stent is designed to remain in the eye permanently.
Relative Size of the XEN Stent
Position of the XEN Stent in the Eye
The XEN stent can be placed in the eye alone or combined with cataract surgery. It is placed through a tiny incision in the cornea that is self-sealing. The recovery is rapid, and most patients can resume regular activities the next day.
The XEN is designed to reduce the risk of problems that are sometimes seen with larger, conventional glaucoma implants.
The XEN represents a major advance in glaucoma surgery because it provides the benefits of good reduction in intraocular pressure seen with larger shunts, with the safety profile seen with the smaller MIGS devices.
As with all glaucoma surgeries, the XEN stent may fail to control the eye pressure at some point after the surgery. If this occurs, additional surgery may be required.
The iStent Micro-Bypass glaucoma implant is the smallest of the MIGS devices. It is used for mild or moderate cases of glaucoma where the intraocular pressure is already adequately controlled with topical medications. The iStent can allow the patient to reduce or eliminate glaucoma eye drops.
The iStent is always placed at the time of cataract surgery. The stent is placed in the trabecular meshwork to allow aqueous to flow more freely and leave the eye through its natural pathway. The iStent is delivered with an injector through the same self-sealing corneal incision used for the cataract surgery. Two individual stents are placed during the same procedure, in separate locations of the trabecular meshwork.
Relative Size of the iStent
Position of iStents in the Eye
Because the device is so small, there are fewer risks of problems associated with it compared to the large glaucoma implants. In addition, it does not add any additional recovery time to the cataract surgery. However, its small size limits the amount of IOP lowering that can be achieved, which is why it is reserved for glaucoma that is at an early stage.
The Hydrus Microstent is a glaucoma implant that is part of the MIGS group of devices. It is used for mild or moderate cases of glaucoma where the intraocular pressure is already adequately controlled with topical medications. The Hydrus can allow the patient to reduce or eliminate glaucoma eye drops.
Relative Size of the Hydrus Stent
Placement of the Hydrus in the Eye
The Hydrus is always placed at the time of cataract surgery. The stent is placed in Schlemm’s canal to allow aqueous to more freely and leave the eye through its natural pathway. The Hydrus is placed with a special delivery device through the same self-sealing corneal incision used for the cataract surgery.
Because the device is so small, there are fewer risks of problems associated with it compared to the large glaucoma implants. In addition, it does not add any additional recovery time to the cataract surgery. However, its small size limits the amount of IOP lowering that can be achieved, which is why it is reserved for glaucoma that is at an early stage.
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