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    MIGS making big difference in glaucoma management

    Microinvasive glaucoma surgery (MIGS) with the trabecular micro-bypass stent (iStent, Glaukos) already has transformed the management of glaucoma and will likely have a bigger impact in the future considering the options in the investigational pipeline and the opportunities for their use, said Steven D. Vold, MD.

    “The trabecular micro-bypass stent has been an exciting breakthrough product that soon after its introduction surpassed trabeculectomies and tubes in combined cataract-glaucoma surgery procedures,” said Dr. Vold, who is in private practice in Fayetteville, AR. “However, this first MIGS device is just the beginning.”

    Dr. Vold added that other devices in the pipeline are providing promising results for patients across a range of glaucoma severity. He presented his observations during the Glaucoma Symposium CME at the 2016 Glaucoma 360 meeting.

    “Through MIGS, we are improving our understanding of aqueous outflow, which is enabling the development of more effective technologies and techniques,” Dr. Vold pointed out. “We can look forward to using MIGS implants with drug delivery to hopefully achieve long-lasting results or with sensors for round-the-clock intraocular pressure (IOP) monitoring.”

    MIGS devices that have completed or are being evaluated in U.S. clinical trials include next-generation trabecular micro-bypass stents (Hydrus, Ivantis; iStent Inject, Glaukos), uveoscleral microstents (CyPass Micro-Stent, Transcend Medical; iStent Supra, Glaukos), and subconjunctival implants (Xen45, Allergan/AqueSys; MicroShunt, InnFocus). Dr. Vold focused on the CyPass Micro-Stent and Xen45 implants, which seem to be the closest to commercial availability in the United States.

    Harnessing uveoscleral outflow

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