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Subspecialties Glaucoma

When MIGS Goes Awry

sponsored by Optotek

The last five years has seen the rise of MIGS – in terms of the “micro invasive” approach, and the devices that go with them. The information that’s currently out there (and there’s little beyond manufacturer-sponsored studies at the moment) suggests that, relative to interventions like trabeculectomy or tube shunts and valves, it’s a relatively safe approach to moderately lower IOP. MIGS, however, is not a panacea. There are other options, such as selective laser trabeculotomy (SLT), to control a patient’s IOP that are often worth pursuing first, and it’s definitely worth bearing in mind that the MIGS umbrella encompasses many unique devices, with unique implantation techniques, unique learning curves – and also unique issues.

Every ophthalmology department has a laser – and it’s more useful than you might think. I want to tell you about how I use YAG and Argon lasers to fix some of the issues that can arise with MIGS devices – and how this can be achieved in the clinic, rather than requiring a return to the operating theater for surgical stent revision.

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  1. SR Wellik, EA Dale, “A review of the iStent(®) trabecular micro-bypass stent: safety and efficacy”, Clin Ophthalmol, 9, 677–684 (2017). PMID: 25931808.

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