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Review
. 2013:2013:705915.
doi: 10.1155/2013/705915. Epub 2013 Nov 27.

Update on Minimally Invasive Glaucoma Surgery (MIGS) and New Implants

Lívia M Brandão  1 , Matthias C Grieshaber  1
Affiliations
Review

Update on Minimally Invasive Glaucoma Surgery (MIGS) and New Implants

Lívia M Brandão et al. J Ophthalmol. 2013.

Abstract

Traditional glaucoma surgery has been challenged by the advent of innovative techniques and new implants in the past few years. There is an increasing demand for safer glaucoma surgery offering patients a timely surgical solution in reducing intraocular pressure (IOP) and improving their quality of life. The new procedures and devices aim to lower IOP with a higher safety profile than fistulating surgery (trabeculectomy/drainage tubes) and are collectively termed "minimally invasive glaucoma surgery (MIGS)." The main advantage of MIGS is that they are nonpenetrating and/or bleb-independent procedures, thus avoiding the major complications of fistulating surgery related to blebs and hypotony. In this review, the clinical results of the latest techniques and devices are presented by their approach, ab interno (trabeculotomy, excimer laser trabeculotomy, trabecular microbypass, suprachoroidal shunt, and intracanalicular scaffold) and ab externo (canaloplasty, Stegmann Canal Expander, suprachoroidal Gold microshunt). The drawback of MIGS is that some of these procedures produce a limited IOP reduction compared to trabeculectomy. Currently, MIGS is performed in glaucoma patients with early to moderate disease and preferably in combination with cataract surgery.

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Figures

Figure 1
Figure 1
Ab interno trabeculotomy with the Trabectome device.
Figure 2
Figure 2
Postsurgery gonioscopic view of ab interno trabeculotomy.
Figure 3
Figure 3
Refluxed blood and bubble formation represent successful photoablation (courtesy of J. Funk, MD, PhD).
Figure 4
Figure 4
Gonioscopic view of implanted transtrabecular microbypass (iStent) in situ (courtesy of Glaukos Corporation).
Figure 5
Figure 5
Microbypass design and dimensions (courtesy of Glaukos Corporation).
Figure 6
Figure 6
Hydrus scaffold design and positioning—illustration. (http://www.revophth.com).
Figure 7
Figure 7
A flexible microcatheter is inserted into Schlemm's canal which is circumferentially viscodilated. The blinking light at the distal tip of the microcatheter helps to identify the track of the microcatheter.
Figure 8
Figure 8
Gonioscopic view of the chamber angle with the suture stent pulling the inner wall of SC towards the anterior chamber.
Figure 9
Figure 9
Stegmann Canal Expander design.
Figure 10
Figure 10
Stegmann Canal Expander in situ (gonioscopic view).
See this image and copyright information in PMC

References

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