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    MICS & MIGS: combined surgery with microstent devices

    Take-home: MIGS is a viable option in patients with mild–moderate glaucoma with an IOP that has been unable to be controlled by medications or who have poor medication compliance. The combination of MICS and MIGS can offer an effective surgical treatment for POAG when the IOP reduction following cataract surgery alone is not sufficient to reduce the need for glaucoma therapies. 

    Reviewed by Christophe Baudouin, MD, PhD, FARVO

    More than 60.5 million people worldwide were affected by glaucoma by the year 2010; this is expected to increase to nearly 80 million by 2020.1 Of these patients, 74% will have primary open-angle glaucoma (POAG), the number two cause of blindness worldwide. Cataract is the leading cause of blindness. It has been shown that the volumetric growth of cataract can be a risk for high ocular pressure and POAG.

    Increasing life expectancy and the high visual requirements of patients have inspired physicians to find new therapeutic strategies to fight these two important causes of blindness. For this reason, new minimally invasive surgery techniques to remove cataract and reduce IOP– microincision cataract surgery (MICS) and micro-invasive glaucoma surgery (MIGS) – have been developed. The two procedures can be performed together.

    MICS is an approach to cataract surgery that uses an incision of less than 2.0 mm to reduce surgical invasiveness and at the same time improve surgical outcomes. This technique is the best to perform in eyes with other diseases, such as POAG, because of the low rate of surgical manipulation and induced inflammations.

    While there had previously been limited surgical options for patients with mild–moderate glaucoma, MIGS procedures are creating new options for patients who do not meet the criteria for trabeculectomy. These procedures have a better safety profile than other invasive techniques, with fewer complications and a more rapid recovery time. They have been shown to be effective in decreasing IOP as well as a patient’s need for medications, which is important given a typically low compliance rate for medication adherence.2

    The main indications for MIGS are POAG with mild–moderate optic nerve damage, pseudoexfoliation glaucoma or pigmentary dispersion glaucoma, POAG uncontrolled with maximum pharmacologic treatment or with barriers preventing adequate medication dosing.

    The main contraindications are angle-closure glaucoma, secondary glaucoma, moderate–advanced POAG, previous unsuccessful glaucoma surgery or severely uncontrolled IOP.3

    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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