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    MICS & MIGS: combined surgery with microstent devices


    There are several definitions of MIGS, but the American Glaucoma Society, which is the largest society of glaucoma specialists in the United States, provides the following working definition:

    ·      IOP lowered by improving the outflow of eye fluid. This is the same mechanism that is used in traditional glaucoma surgery.

    ·      Approach from inside the eye.

    ·      Limited surgical manipulation of the sclera.

    ·      Little manipulation of the conjunctiva.

    In meeting these criteria, MIGS procedures do not preclude the possibility of future, more traditional surgical approaches such as trabeculectomy or tube shunt surgery.

    Overall, MIGS procedures have been touted as safer than traditional trabeculectomy or tube shunt surgeries. This is because they do not have some of the associated complications of the traditional procedures, such as low eye pressure (hypotony) and bleb infection.

    Many MIGS procedures involve the implantation of small devices. MIGS procedures are generally faster than trabeculectomy and tube shunt surgeries, and shortened surgical time can be very important for the safety of the patient. Many MIGS procedures are combined with cataract surgery, adding a short amount of time to the total surgical procedure.

    Lastly, an important point is that while most MIGS procedures are safe, they are less effective than other traditional surgical procedures in lowering eye pressure, for example in patients affected by severe glaucoma with IOP greater than 30 mmHg.

    MIGS with microstents can provide an effective way to treat glaucoma in a less invasive manner and earlier in the disease process. Although good surgical skills and experience are required, recovery is faster and there are fewer complications compared with traditional procedures, as tissue dissection is not required.

    Dr Antonio Toso

    Dr Antonio Toso is the director of the Vitreo?Retinal Surgery Unit in the Ophthalmic Department of the St Bassiano Hospital in ...

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