MIGS & MIBS: Changing Times for Glaucoma

The arrival of minimally invasive glaucoma surgery (MIGS) in 2009 heralded huge changes in the way surgeons operated. But what about the patients themselves? To better understand just how much MIGS has influenced the characteristics of first-time glaucoma patients, a Journal of Clinical Medicine retrospective study reviewed the data from 455 patients whose glaucoma surgeries were performed by two surgeons at the University of Pisa, Italy, from January to December 2011 and January to December 2021.

The data included visual field parameters, disease stage, central corneal thickness, intraocular pressure (IOP), as well as the type of surgery performed on the patient. In the 2021 data, it was noted that minimally invasive bleb surgery (MIBS) – as represented by the only two MIBS devices currently available worldwide, the PRESERFLO MicroShunt and the XEN Gel Stent – made up 58 percent of all the surgeries analyzed.

“The introduction of minimally invasive glaucoma surgery (MIGS) – and, in particular, minimally invasive bleb surgery (MIBS) procedures – has led to earlier surgical timing of glaucoma patients,” explains Michele Figus, lead study author and a Professor in Ophthalmology and Chairman in the Residency Training Program in Ophthalmology at University of Pisa. “MIBS has a higher safety profile than traditional surgery, making it possible to perform on younger patients with an earlier stage of disease. In addition, anticipating surgery reduces chronic exposure of conjunctiva to lowering IOP eye drops, which is known to be a major cause of failure of glaucoma filtration surgery.”

Figus notes that those patients who received glaucoma surgery in 2011 “were older, had higher preoperative intraocular pressure, and had a larger perimetric defect at the visual field examination” than those who were operated on a decade later.

He feels that these changes to the baseline features of patients signal a positive direction for glaucoma surgery. In the future, he says, “advancements in surgery may make it possible to control the disease more effectively and reduce the need for daily ocular topical therapy.”