Minimally Invasive Glaucoma Surgery (MIGS)
What is MIGS?
Minimally-invasive glaucoma surgery encompasses new devices that seek to lower eye pressure and is best suited for patients with mild to moderate glaucoma. It is is often performed in conjunction with cataract surgery. Its advantages are less surgical manipulation and risk, and faster recovery.
All MIGS procedures have the following characteristics that distinguish them from traditional glaucoma surgery:
‘Minimally traumatic’ to eye structures
Performed within the eye and hence preserves the conjunctiva, the eye’s natural lining
High safety profile
Relatively quick with rapid recovery
Frequently combined with cataract surgery
Multiple treatments are possible
iStent device
MIGS involves placement of a microscopic stent that allows fluid to escape from the eye. If combined with cataract surgery, adding a glaucoma stent at the end of the operation adds little risk and may reduce or stop your need for glaucoma drops. Mr Agrawal offers the most popular and established device in Ireland – the iStent device.
The iStent inject
The iStent device
The iStent inject is a small (1mm long) titanium tube that is implanted into the eye to lower intraocular pressure and reduce the need for eye drops in patients with ocular hypertension or primary open angle glaucoma.
The iStent is inserted into the eye’s natural drainage channel – the trabecular meshwork. The aqueous humour is then able to bypass the trabecular meshwork and drain through the iStent lowering the eye pressure (IOP) as well as the need for glaucoma eye drops. Insertion of the iStent involves a short surgical procedure that is often performed at the same time as cataract surgery, usually as a day case procedure. The implantation of the iStent only adds an addition 5-10 minutes to the surgical time of the cataract surgery. The operation is usually performed under local anaesthetic using eye drops to numb the eye (topical anaesthesia).
The iStent device
What is the success rate of MIGS?
The success rate for this treatment is very promising. A large randomised study in the USA, involving almost 500 patients, randomly assigned patients to have cataract surgery alone or cataract surgery with iStent. 76% of patients treated with the Stent had at least a 20% reduction in IOP compared to 60% of those having cataract surgery alone at 2 years.
The iStent is made from non-magnetic titanium, the same material used for replacing heart valves so it will not cause an allergic reaction or be rejected by the body. As it is non-magnetic it is safe for you to have an MRI scan in the future if needed. The iStent will not set off airport scanners.