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Micro Invasive Glaucoma Surgery (MIGS)

If you’ve been managing your glaucoma symptoms with eye drops or medication, and have a cataract diagnosis, you may be an ideal candidate for Microinvasive Glaucoma Surgery (MIGS). MIGS is a group of procedures that aim to lower the eye pressure without risking significant complications that are seen with major glaucoma surgeries such as trabeculectomies and tube shunts.

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Benefits of MIGS Include:

  • Convenient & Effective: In the past, patients had to undergo two separate surgeries to treat glaucoma and cataracts. Today, MIGS provides a unique opportunity to reduce glaucoma symptoms and correct vision loss from cataracts in one simple procedure.
  • Precise & Predictable: The microscopic instruments used in MIGS were precision-engineered to provide surgeons with a straightforward, accurate, and secure method of glaucoma treatment.
  • Safety: Fewer complications and faster visual recovery are seen with MIGS.
  • Clinically Proven: MIGS are clinically proven and approved by the FDA to treat forms of open angle glaucoma.

What is the iStent?

The iStent is a MIGS microscopic implant used to treat high eye pressure caused by primary open angle glaucoma. Measuring only 1mm in length and 0.3mm in height, the iStent is the smallest medical device ever approved by the FDA. It is also the smallest device known to be implanted in the human body.

iStent on Top of a Penny

What is iStent inject®?

The iStent inject is a second-generation version of the iStent implant for glaucoma. The newer procedure involves the injection of two stents into the drainage canal of the eye instead of one, which results in a more consistent and longer-lasting reduction of eye pressure. Some surgeons also find the iStent inject device easier to use, which can improve accuracy and precision when placing the stents inside the eye.

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How Does the iStent Work?

The front of the eye is filled with a clear fluid called aqueous humor. In a healthy eye, the fluid flows freely through the trabecular meshwork, the spongy tissue at the front of the eye, and into a drainage canal. When the fluid drains properly, intraocular pressure remains normal.

In a patient with open angle glaucoma, the fluid does not flow freely through the trabecular meshwork. This causes a buildup of aqueous humor, which results in high eye pressure levels that can damage the optic nerve and cause vision loss.

The iStent works by creating a bypass between the trabecular meshwork and the natural drainage pathway of the eye. This allows excess fluid to drain properly, thereby causing a reduction in eye pressure levels. Lowering intraocular pressure can significantly reduce the risk of optic nerve damage and prolong vision in glaucoma patients.

What is the Hydrus Microstent?

The Hydrus implant is a microscopic device the size of an eyelash that stents the trabecular meshwork or drainage canal open and improves outflow capability, thus lowering your eye pressure. This stent is also performed only at the time of cataract surgery for patients with mild to moderate open angle glaucoma.

What is the OMNI Microinvasive Glaucoma Surgery?

The Omni surgery uses a microscopic device to cannulate and open up the trabecular meshwork or drainage canals. This procedure can target 360 degrees of the drainage canal and is implant free. It can also be performed with cataract surgery but also as a standalone procedure.

Why are the iStent and Hydrus Stents Inserted During Cataract Surgery?

Removing the eye’s natural lens during cataract surgery can improve the outflow of fluid and result in a natural reduction in intraocular pressure. This physiological reaction provides the best opportunity to treat glaucoma patients, as eye pressure can be lowered even further using one of the MIGS devices mentioned above.

Who is a Candidate for MIGS?

MIGS is most often recommended for patients who have stable, mild to moderate primary open angle glaucoma and a cataract diagnosis. To find out if you’re a candidate, contact us to meet with a glaucoma specialist. The Nielsen Eye Center provides glaucoma treatment in Boston and all of the South Shore, such as Quincy, Weymouth, Norwell, and Norwood MA.

What to Expect With MIGS?

  • Before the procedure: Your doctor will advise you to continue the use of prescription eye drops until your procedure is complete and your eye pressure levels are evaluated. You will also be asked to provide a list of all the medications you currently take, as well as answer questions in regard to your medical history.
  • During the procedure: Cataract removal and iStent implantation are performed under local anesthesia. Since the eyes are numbed prior to surgery, you’ll feel no pain. Once the cataracts are removed, your surgeon will implant the iStent or Hydrus device. Depending on the skill level of your doctor, insertion of the iStent or Hydrus stent can take as little as two minutes.
  • After the procedure: The iStent or Hydrus procedure is performed in an outpatient facility, which means patients are able to go home the same day of the surgery. Your doctor will prescribe antibiotic and anti-inflammatory eye drops to help reduce irritation and the risk of infection.

A follow-up appointment is typically scheduled for the next day, which helps to monitor eye pressure levels and ensure the efficacy of the procedure. It’s important to avoid any activity that may result in an increase in eye pressure, such as sports, heavy lifting, or other forms of physical strain. The majority of patients are back to their normal routine within a week or less.

What are the Risks?

MIGS have a very low risk of complications. However, there are risks associated with cataract surgery that may include inflammation or infection. It’s also normal to experience a small amount of bleeding where the stents are inserted. This is usually temporary and resolved with topical eye medication.

Very rarely, the stents may become obstructed or dislocated. Medications, laser treatment, or repositioning of the stent can fix these issues.

MIGS, Boston

Curious to know if you’re a candidate for MIGS? The Nielsen Eye Center is dedicated to offering patients the most advanced glaucoma treatment in the Greater Boston area. Our team of board-certified ophthalmologists are proud to offer MIGS for glaucoma in Boston and all of the South Shore, such as Quincy, Weymouth, Norwell, and Norwood MA. Schedule an appointment at a location near you today!