MIGS - Small Incisions with Big impact!
Updated: Nov 16
What is MIGS?
One must have heard about MIVS which stands for Minimally Invasive Vitrectomy Surgery. MIGS could be called its sister concern and stands for Minimally Invasive Glaucoma Surgery. MIGS have been present for an appreciable amount of time in the past, they have garnered a lot of interest in recent years. Touted to be the next paradigm shift in the management of glaucoma and are being likened to what anti-VEGFs were for vitreo-retina.
How are they different from a traditional trabeculectomy? Well, majority if not all. are independent of a surgically induced filtering bleb. They are group of surgeries which are performed using a smaller incision than the traditional trabeculectomy. Means the healing is faster with carries lesser risk for infection and bleeding.
Why do we need MIGS?
Before we start talking about MIGS let us know more about why it is needed. We know the success of a traditional trabeculectomy depends on the health of the filtering bleb.
An ideal bleb is diffuese, minimally levated, microcystic and relatively avascular. But do we always get these features? Even in the best of hands, a surgical bleb may fail. And failure can be due scarring, blebitis, overfilteration, underfilteration, encapsulation, overhanging among others. These factors can be manipulated to a great extent but may still be dependent on the preoperative dry eye, ocular surface disease, use of anti-glaucoma medications with preservatives and steroids etc.
This probably lead to the thought of why not circumnavigate the filtering bleb and think of a novel approach altogether?
What is MIGS again!
MIGS are surgeries or devices which have the following basic characteristics: minimally invasive, ore effective, higher safety profile, quicker to perform and flatter curve of learning. Also these surgeries can be very well combined with a clear cornea phacoemulsification.
MIGS is indicated for patients with glaucoma less severe than that requiring traditional trabeculectomy
Anatomy of the angle of Anterior Chamber
Let us revise the anatomy of the angle of the anterior chamber (AC). The angle of the AC is formed by the trabecular meshwork, scleral spur, ciliary body and the iris. The trabecular meshwork in turn can be divided into 3 parts from internal to external - uveal, corneoscleral and juxtacanalicular (providing maximum resistance to outflow) meshworks.
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