Glaucoma management has changed significantly over the last decade
Especially with the introduction of Minimally Invasive Glaucoma Surgery, commonly known as MIGS. These procedures have opened new options for patients with mild to moderate glaucoma, offering effective pressure control with a better safety profile than traditional surgery.
It is important to understand that MIGS is not a single device or a single technique. Instead, it represents a group of surgical devices and procedures. Each one is designed to target a specific outflow pathway, and the choice depends on the patient’s diagnosis, anatomy, disease stage, and the surgeon’s preference and experience.
Who Benefits Most From MIGS?
MIGS procedures are especially helpful for patients with early to moderate glaucoma who require additional intraocular pressure reduction but may not be ideal candidates for trabeculectomy. These patients often want faster recovery, fewer complications, and a lower long-term risk profile. MIGS can also be combined with cataract surgery, making them even more attractive in routine clinical practice.
Different Types of MIGS Devices
Some MIGS devices are tube-based implants. These create an alternative drainage pathway and can serve as a safer option compared to traditional trabeculectomy with mitomycin C. While trabeculectomy remains the gold standard for advanced glaucoma, it carries higher risks and requires intensive postoperative care. Tube-based MIGS procedures, on the other hand, involve fewer surgical steps and significantly shorter operating times.
Another category of MIGS includes devices that are carefully injected into the anterior chamber angle using a gonioscopic lens. These procedures require precise visualization and good angle anatomy. A critical point during these surgeries is ensuring adequate aqueous outflow. If the first device does not drain properly, the surgeon may need to implant an additional one. This step requires judgment, experience, and comfort with angle surgery.
There are also goniotomy-based MIGS devices. Some of these are equipped with built-in illumination and guiding systems, which help the surgeon navigate Schlemm’s canal more accurately. These innovations have improved surgical confidence and consistency, especially for surgeons transitioning into MIGS techniques.
Simpler Surgery, Faster Recovery
One of the strongest advantages of MIGS is the relative simplicity of the procedures. The surgeries are shorter, the tissue disruption is minimal, and the postoperative recovery is faster compared to conventional glaucoma surgery. Patients typically experience less inflammation and fewer complications, making MIGS an appealing option for both surgeons and patients.
Cost and Availability: A Major Limitation
Despite their benefits,
MIGS devices come with a significant limitation. Cost remains a major barrier, particularly in developing countries. At present, many of these devices are not readily available in Pakistan. Even when they do become available, there will be a learning curve. Surgeons will need structured training and hands-on experience to use these devices safely and effectively.
Looking Ahead
Glaucoma care continues to improve as science and technology advance. MIGS represents an important step forward, offering patients safer surgical options and giving surgeons more flexibility in treatment planning.
The efforts of professional bodies like the BPOS will be remembered for their role in advancing ophthalmic education in Pakistan. In particular, the dedication of Dr. Rashid Zia in training Pakistani ophthalmologists in glaucoma care deserves recognition. His work has helped prepare the ground for modern glaucoma management and will continue to benefit patients as new technologies become accessible.
As MIGS devices
eventually enter the local market, they will not replace traditional surgery but will complement it. Together, these tools allow for more personalized, safer, and effective glaucoma treatment, which is ultimately the goal of modern ophthalmology. #MIGS #IOP #Glaucoma #Innovation #Benefit
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