COMMENTARY

Looking Back on an Innovative Year in Ophthalmology

Ronald C. Gentile, MD; Tal Raviv, MD; Joseph F. Panarelli, MD; Richard B. Rosen, MD

Disclosures

December 29, 2014

In This Article

Refining Glaucoma Surgery

Although the exact definition of what constitutes microinvasive glaucoma surgery (MIGS) will vary, it has been defined as glaucoma surgery that lowers intraocular pressure by improving the outflow of aqueous humor with limited surgical manipulation of the conjunctiva or sclera.[16] Most are ab interno procedures performed through a small corneal incision. MIGS is best suited for the treatment of mild to moderate glaucoma rather than more advanced disease, and it is characterized as having a favorable safety profile.

The popularity of MIGS proliferated in 2014 for a variety of reasons[17,18]:

Less hypotony and associated complications compared with traditional glaucoma surgeries;

Ability to be performed by a comprehensive ophthalmologist without glaucoma training;

Can be performed in combination with cataract surgery; and

Does not preclude future traditional glaucoma surgery (ie, trabeculectomy or tube shunt surgery).

As with any new procedure, there is a learning curve that must be overcome when first implementing these devices. The devices that are generally accepted as belonging to the MIGS family are Trabectome® (NeoMedix; Tustin, California), iStent® (Glaukos; Laguna Hills, California), XEN Gel Stent (AqueSys; Irvine, California), Hydrus™ intracanalicular implant (Ivantis; Irvine, California), and CyPass Micro-Stent® (Transcend Medical; Menlo Park, California). Although some have not yet been approved by the FDA, the Trabectome and the iStent were the first to become available to ophthalmic surgeons in the United States.

There is hope that MIGS will soon be able to bridge the wide gap that exists between medical treatment and filtering surgery for patients with glaucoma.

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