MIGS take away points
It’s not just trabs and tubes anymore: from most invasive to microinvasive
TAKE AWAY POINT No. 1: Poor adherence is common
Poor adherence to treatment is relatively common among glaucoma patients and is associated with progression of disease. Quite often, medical treatment for glaucoma is suboptimal.
TAKE AWAY POINT No. 2: There are four routes by which to surgically lower IOP
1. increase trabecular outflow
2. increase uveoscleral outflow
3. decrease aqueous fluid production
4. increase aqueous outflow into the subconjunctival space
TAKE AWAY POINT No.3: The term MIGS was coined in 2009 by Dr. Ike Ahmed
There is currently no single common and widely accepted definition of MIGS. It was originally known as “minimally invasive” but has since evolved to “microinvasive”.
According to Saheb and Ahmed, the term MIGS refers to a group of surgical procedures which share five preferable qualities (Saheb H, Ahmed II. Micro-invasive glaucoma surgery: current perspectives and future directions. Curr Opin Ophthalmol. 2012;23(2):96–104):
1. an ab interno approach through a clear corneal incision which spares the conjunctiva of incision
2. a minimally traumatic procedure to the target tissue
3. an IOP lowering efficacy that justifies the approach
4. a high safety profile avoiding serious complications compared to other glaucoma surgeries
5. a rapid recovery with minimal impact on the patient’s quality of life.
TAKE AWAY POINT No. 4: MIGS is NOT a replacement for filtration surgery.
Filtration surgery is still indicated in:
1. angle closure glaucoma
2. when very low target IOP are needed: severe/advanced glaucoma and normal tension
glaucoma
TAKE AWAY POINT No. 5: Treatment algorithm
Mild glaucoma – Pharmacotherapy and selective laser trabeculoplasty (SLT)
Moderate glaucoma – MIGS (combined with cataract extraction or stand alone)
Severe glaucoma – Filtration surgery +/- cataract extraction (trabeculectomy +/- anti-metabolite and tube shunt surgery)
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