In a trabeculectomy the ophthalmic surgeon … Combining minimally invasive glaucoma surgery procedures is a feasible, versatile alternative for lowering IOP and minimizing the side effects of a surgical approach to glaucoma, … J Cataract Refract Surg; 34(7). Uram M. Endoscopic Cyclophotocoagulation in Glaucoma Management. Copyright © Queen's Printer for Ontario, 2019. Purpose: The last decade has witnessed an unprecedented growth in glaucoma treatment options through the introduction of minimally invasive glaucoma surgeries (MIGS).The aim of the present … Reiss G, Clifford B, Vold S, He J, Hamilton C, Dickerson J, Lane S. Safety and Effectiveness of CyPass Supraciliary Micro-stent in Primary Open-Angle Glaucoma: 5-Yaer Results from the COMPASS XT Study. 18. Gonioscopy assisted transluminal trabeculotomy: an ab interno circumferential trabeculotomy for the treatment of primary congenital glaucoma and juvenile open angle glaucoma. Am Fam Physician. Since the original publication, Grover and colleagues have reported the successful use of the GATT technique in primary congenital glaucoma, juvenile open angle glaucoma, and even eyes with prior incisional glaucoma surgery.14,15 These early results represent a promising, conjunctival sparing technique that can be used in conjunction with, or independent of cataract surgery. Even in patients who respond to medical therapy, there are several barriers to adequate therapy that may limit their long term utility. 26. http://glaucomaassociates.com/gonioscopy-assisted-transluminal-trabeculotomy/, 27. https://www.youtube.com/watch?v=1laohyDLi2A. Hydrus plus phacoemulsification group went from 1.7±0.9 drops to 0.3±0.8 drops at 24 months after surgery while the phacoemulsification alone group went from 1.7±0.9 drops to 0.7±0.9 drops at 24 months.18. The mean IOP reduction was 7.3±6.7 mmHg and 59% of eyes experienced a ≥20% reduction in IOP. Surgical technique utilized in this study included conjunctival cut-down, pre-treatment with mitomycin C soaked sponges followed by ab interno implantation of the Xen gel stent and then conjunctival closure. Gallardo et al. Samuelson T, Katz LJ, Wells JM, Duh Y, Giamporcaro J. Randomized Evaluation of the Trabecular Micro-Bypass Stent with Phacoemulsification in Patients with Glaucoma and Cataract. CADTH OPTIMAL USE Optimal Use of Minimally Invasive Glaucoma Surgery: Recommendations 6 Technology MIGS are devices and procedures that are used with the aim of lowering the pressure … Brian A. Francis, Kuldev Singh, Shan C. Lin, Elizabeth Hodapp, Henry D. Jampel, John R. Samples, Scott D. Smith, Novel Glaucoma Procedures: A Report by the American Academy of Ophthalmology. The probe comes in a 19, 20, or 23 gauge size that is either straight or curved and is inserted into the anterior chamber through a clear corneal incision. Two combined MIGS procedures. We derived costs from the collaborative health technology assessment.1 We assumed MIGS may be used in three subgroups: (1) MIGS in combination with cataract surgery as a replacement for cataract surgery alone in people with mild to moderate glaucoma; (2) MIGS alone as a replacement for other glaucoma treatments in people with mild to moderate glaucoma; and (3) MIGS (alone or in combination with cataract surgery) to replace filtration surgery (alone or in combination with cataract surgery) in people with advanced to severe glaucoma. A study by Sarkisian et al. At 1 year post-operatively, eyes that underwent phacoemulsification with KDB goniotomy experienced a significant reduction in mean IOP from 16.8±0.6 mmHg at baseline to 12.4+0.3 mmHg, 57.7% of eyes experienced a 20% reduction in IOP and the number of medications decreased from 1.6±0.2 to 0.8±0.1 eye drops.21. 21. evaluated the safety and efficacy of TRAB360 in patients with refractory primary open angle glaucoma. USA.gov. A total of 546 patients with primary open angle glaucoma who had visually significant cataracts, IOP between 22-34 mmHg, and who were on between 1-4 hypotensive eye drops were enrolled. Eyes in groups 2 had a mean baseline IOP of 14.9±1.8 mmHg and a post-operative mean IOP of 13.6±2.3 mmHg with no significant difference between the two time points. Continuous irrigation and aspiration allows for removal of debris and regulation of temperature. Desser AS, Arentz-Hansen H, Fagerlund BF, Harboe I, Lauvrak V. Oslo, Norway: Knowledge Centre for the Health Services at The Norwegian Institute of Public Health (NIPH); 2017 Aug 25. Hydrus plus phacoemulsification group went from 1.7±0.9 drops to 0.3±0.8 drops at 24 months after surgery while the phacoemulsification alone group went from 1.7±0.9 drops to 0.7±0.9 drops at 24 months. Dr Chelvin Sng (MBBChir, MA, FRCSEd) graduated from Cambridge University, UK, with triple first class honours and distinctions.She is amongst the first surgeons in Asia to be accredited in the use of several micro-invasive glaucoma surgery (MIGS) devices, including the iStent trabecular microbypass stent, the iStent Inject, the XEN-45 gel stent and the trabectome. The juxtacanalicular trabecular meshwork has traditionally been identified as the site of greatest resistance to aqueous outflow. Minimally invasive glaucoma surgery: current status and future prospects. J Cataract Refract Surg; 34(7). Of the 72 eyes in group 1, 11 underwent VISCO360 alone and 61 underwent VISCO360 with cataract extraction. How minimally invasive glaucoma surgery reduces risk to patients. Patients can be phakic, pseudophakic or aphakic. 12-Month Outcomes of Goniotomy Perfored Using the Kahook Daul Blade Combined with Cataract Surgery in Eyes with Medically Treated Glaucoma. 2. doi: 10.1371/journal.pone.0183142. This approach is employed in endocyclophotocoagulation (ECP) during which a laser endoscopic probe is inserted through a clear corneal incision and used to directly visualize and ablate the ciliary body. MIGS are a family of procedures characterized by the use of microscopic-sized equipment and tiny incisions that provide an alternative to traditional, more invasive glaucoma … One Device. 7. It was a prospective, single-masked, multi-center study with 505 eyes randomized 3:1 to iStent plus phacoemulsification (n=387) or phacoemulsification alone (n=118). With the microcatheter still in Schlemm’s canal, the device is retracted from the eye tearing the microcatheter through the trabecular meshwork for 180 degrees. The HORIZON study was the pivotal study for approval of the Hydrus microstent; it compared phacoemulsification alone to phacoemulsification with Hydrus microstent implantation. There were no subsequent surgical interventions related to the VISCO360. Dilation of Schlemm’s canal through cannulation and expansion with viscoelastic is yet another approach to improve outflow through the normal physiologic aqueous outflow system. Minimally invasive glaucoma surgery (MIGS) The new technologies and devices, known as MIGS, aim to lower IOP with a higher safety profile than fistulizing surgery (trabeculectomy/drainage tubes). Art of Minimally Invasive Glaucoma Surgery. Greenwood M, Seibold L, Radcliffe N, Dorairaj S, Aref A, RomanJ, Lazcano-Gomez G, Darlington J, Abdullah S, Jasek M, Bahjri K, Berdahl J. Goniotomy with a single-use dual blade: Short term results. This article examines MIGS and its potential benefits for glaucoma patients. Minimally invasive surgery is at the forefront of newer advances in the management of glaucoma. It can be performed as a stand-alone procedure or can be performed in conjunction with cataract surgery. The most common complication was a transient hyphema reported in 30% of patients at 1 week post-operative follow-up, which resolved by one month. This approach is employed during endocyclophotocoagulation in which an endoscopic laser probe is inserted through a clear corneal incision and used to directly visualize and ablate the ciliary body. There is a spectrum of current treatments for glaucoma that aim to reduce intraocular pressure (IOP), including pharmacotherapy (eye drops), laser therapy, and the more invasive option of filtration surgery. These barriers include noncompliance with the prescribed regimen, intolerance of medication side effects, financial burden limiting access to medications, or physical inability to reliably self-administer eye drops. After implantation, the gelatin in the stent hydrates slightly causing expansion of the device to ensure improved stability. Grover DS, Flynn WJ, Bashford KP, Lewis RA, Duh YJ, Nangi RS, Niksch B. The gel stent is loaded in a single-use, single-handed disposable injector with a 27-gauge needle. Furthermore, the average number of IOP lowering drops decreased from 2.8±0.9 drops to 1.1±1.1 drops, which represents a 60.0% reduction on average. Distelhorst JS, Hughes GM. Br J Ophthalmol. At 6 months, mean IOP decreased from 17.4±5.2 mmHg to 12.8±2.6 mmHg, and 58.3% of patients had an IOP reduction of ≥20% from baseline. Combined iStent trabecular micro-bypass stent implantation and phacoemulsification for coexistent open-angle glaucoma and cataract: a long-term study. As surgeon experience expands and the number of MIGS approaches grows, these procedures may even be utilized in more severe cases and across a wide range of clinical scenarios. The uveoscleral outflow pathway can be augmented by accessing the suprachoroidal space with microstent placement. General disadvantages are the risk of cleft closure from residual TM leaflets and IOP reduction is limited by episcleral venous pressure and Schlemm’s canal resistance. 360. Trabectome is a surgical system developed by NeoMedix (Tustin, CA). evaluated the safety and efficacy of ECP in refractory glaucoma of multiple subtypes. For decades, this left clinicians and patients with a treatment gap of limited options for patients with mild to moderate disease who had uncontrolled IOP despite medical and laser therapy. Background: Minimally invasive glaucoma surgery, or micro-invasive glaucoma surgery, is commonly called MIGS, and it is an advanced approach to glaucoma treatment. Patients who received iStent at the time of phacoemulsification also had a mean IOP reduction of 7.0 ± 4.0 mmHg compared to 5.4 ± 3.7 mmHg in the patients who underwent phacoemulsification alone. Adherence with topical glaucoma medication monitored electronically the Travatan Dosing Aid study. 369 eyes underwent phacoemulsification with Hydrus microstent implantation and 187 eyes underwent phacoemulsification alone. Samuelson T, Sarkisian S, Lubeck D, Stiles M, Duh Y, Romo E, Giamporcaro J, Hornbeak D, Katz LJ, iStent inject Study Group. Viscodilation of Schlemm’s Canal for the Reduction of IOP Via an Ab-interno Approach. Each stent is 360 microns in height by 230 microns in diameter; consisting of a tapered head with a recessed thorax and a terminal flange. Particularly in pigmentary glaucoma patient, who do not respond to laser treatment, the use of iTrack is a minimally invasive surgical treatment option that is safe and effective, providing an alternative to more invasive glaucoma … Laser setting start at 0.2-0.25 Watts, continuous cycle and power is titrated to achieve both blanching and contraction of the ciliary processes. Mean change in unmedicated IOP at 24 months post-surgery was -7.6±4.1 mmHg in the Hydrus group compared to -5.3±3.9 mmHg in the phacoemulsification alone group. Richter G, Coleman AL. What is Minimally Invasive Glaucoma Surgery? Minimally invasive glaucoma surgery Trabeculectomy or its modification remains the operation of choice for most surgeons. Ophthalmology 2009;116:191-9. There were 85 eyes of 85 patients included: 57 patients with primary open angle glaucoma showed an average IOP decrease of 11.1 ± 6.1 mm Hg and patients required 1.1 fewer drops at 1 year post-operatively.13 For the 28 patients with other forms of open angle glaucoma, IOP decreased an average of 19.9 ± 10.2 mm Hg and patients required 1.9 fewer IOP lowering medications at 1 year post-operative. Additionally, the tip of the Trabectome is bent at a 90° angle to create a protective triangular footplate and allow for easier insertion into Schlemm’s canal and is coated to facilitate smooth movement within the canal. (2014) compared IOP reduction with phacoemulsification alone to ECP with phacoemulsification. The Kahook Dual Blade (New World Medical, Rancho Cucamonga, CA) is a specialized goniotomy blade that was introduced in the United States in 2015. 28. While traditional glaucoma surgery involves making a large incision or placing a large tube in the eye to lower the pressure, Dr. Song thought she was a good candidate for a newer, minimally invasive glaucoma surgery (MIGS). Helmut H, Ahmed IK, Grisanti S, et al. The device was withdrawn from the market in August 2018 based on results of the 5-year COMPASS-XT trial which demonstrated a significant decrease in corneal endothelial cell counts in patients undergoing CyPass with phacoemulsification compared to patients undergoing phacoemulsification alone. There was a significant reduction in medications at 12 months from 1.8±0.9 to 0.2±0.6 post-operatively. General advantages of these MIGS procedures are the ability to bypass the trabecular meshwork and form a direct pathway to Schlemm’s canal for 3-4 or more clock hours. For the people with glaucoma we spoke with, avoiding blindness was their paramount concern, and MIGS was perceived as an effective treatment option with minimal side effects and recovery time required. A total of 546 patients with primary open angle glaucoma who had visually significant cataracts, IOP between 22-34 mmHg, and who were on between 1-4 hypotensive eye drops were enrolled. Often our patients are able to stop one or more of their glaucoma medications at the time of cataract surgery. 10. Once it has been passed through the entire canal, the distal end of the catheter is grasped and the proximal end is retracted out of the eye, shearing the trabecular meshwork to create a 360-degree trabeculotomy. There were 81 eyes of 57 patients with various types of glaucoma (angle closure, congenital, inflammatory, neovascular, steroid-induced and open angle glaucoma) that underwent TRAB360 as a stand-alone procedure. MIGS procedures are an especially useful treatment option in patients with poor medication tolerance, poor compliance and patients who need more IOP-lowering than drops or laser trabeculoplasty can provide. Sutureless Aortic Valve Replacement for Treatment of Severe Aortic Stenosis: A Single Technology Assessment of Perceval Sutureless Aortic Valve [Internet]. It was a prospective, randomized trial that included 240 eyes with mild to moderate glaucoma and intraocular pressure less than or equal to 24 mmHg on one to three drops. Sarkisian S, Mathews B, Ding K, Patel A, Nicek Z. 31. Over the past 5-10 years there has been a revolution in glaucoma surgery, specifically Micro-Invasive Glaucoma Surgery, commonly called MIGS. MIGS procedures involve a minimally invasive approach, often with small cuts or micro-incisions through the corneathat causes the least amount of trauma to surrounding scleral and conjunctival tissues. Another mechanism to achieve IOP reduction in MIGS is the decrease of aqueous production through ablation of the ciliary body. Dorairaj S, Seibold LK, Radcliffe N, Aref A, Jimenez-Roman J, Lazcano-Gomex G, Darlington J, Mansouri K, Berdahl J. 22. A Schlemm Canal Microstent for Intraocular Pressure Reduction in Primary Open-Angle Glaucoma and Cataract: The HORIZON Study. There were no cases of hypotony or phthisis and only four eyes lost 2 or more lines of Snellen visual acuity.32 ECP is commonly combined with phacoemulsification and the addition of ECP offers both a significant IOP and medication reduction compared to phacoemulsification alone.33 Francis et al. MIGS stands for microinvasive (or minimally invasive) glaucoma surgery. Average number of IOP lowering mediations decreased from 3.5 drops at baseline to 1.7 at 1 year post-operative. While all types of glaucoma surgery share the same goal of lowering eye pressure, MIGS has been specifically developed with the goal of reducing the risk of complications associated with traditional glaucoma surgeries. Importantly, no implant is required and these goniotomy/trabeculotomy procedures can be performed as a standalone procedure or combined with simultaneous cataract surgery. Am J Ophthalmol 2019; 208: 219-225. 2019 Feb 19;19(3):1-223. eCollection 2019. The CyPass Micro-Stent (Alcon, Fort Worth, Texas) is a polymide, supraciliary device for ab-interno implantation. The study included 71 eyes from a mixed population of patients with mild to severe glaucoma of various types, including primary open angle glaucoma, pigmentary glaucoma, pseudoexfoliation, normal tension glaucoma and angle closure glaucoma. 30. | Types of MIGS procedures include: Microtrabeculectomy (miniaturized version of a standard trabeculectomy) Most of the fluid inside the eye normally drains through porous tissue called the trabecular meshwork. Results: Ophthalmol Ther 2018;7:203-210. With the influx of MIGS devices, it can be challenging to evaluate both the indications and the outcomes for these devices. Gallardo M, Supnet R, Ahmed II. Another approach to bypass the resistance of the trabecular meshwork is goniotomy or trabeculotomy which involves surgical incision and/or excision of this tissue and allows for improved aqueous outflow into Schlemm’s canal. 90% of eyes achieved an IOP of £21 mmHg by final follow-up. Clinical Ophthalmology 2018; 12: 2149-2155. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. It can be performed in phakic or pseudophakic patients. Minimally invasive glaucoma surgery 1. 2013;39(3):431-437. Microsurgical forceps are used to advance the microcatheter or suture into Schlemm canal circumferentially 360 degrees. Many new micro-surgical techniques for glaucoma, often referred to as MIGS (Minimally Invasive Glaucoma Surgery) are now available in several parts of the world and may be useful for the individual patient depending on the type of disease and its severity. Samples JR, Singh K, Lin SC, et al. This approach allows for enhancement of the natural outflow system without tissue destruction. 20. Report from the Norwegian Institute of Public Health No. Most MIGS operations are designed to allow extra fluid to leave the eye, and hence lower the IOP. Ophthalmology, Volume 118, Issue 7, July 2011, Pages 1466-1480. At 1 year post-operative follow-up, 40% of eyes were off all IOP lowering drops.24. Learning Objectives. Prospective Randomized, Controlled Pivotal Trial of an Ab Interno Implanted Trabecular Micro-Bypass in Primary Open-Angle Glaucoma and Cataract: Two-Year Results. Mean change in unmedicated IOP at 24 months post-surgery was -7.6±4.1 mmHg in the Hydrus group compared to -5.3±3.9 mmHg in the phacoemulsification alone group. The time involved for iStent inject surgery is 15 minutes under topical or local anaesthesia. Bypass can be achieved by placing a trabecular meshwork bypass stent which allows aqueous to flow directly through the stent from the anterior chamber into Schlemm’s canal. Laser trabeculoplasty for open-angle glaucoma: a report by the American academy of ophthalmology. Sarkisian S, Mathews B, Ding K, Patel A, Nicek Z. There is a snorkel that is 0.25mm in height with a central lumen of 120 microns which projects into the anterior chamber. Br J Ophthalmol. Outcome measures included IOP reduction after surgery, proportion of eyes achieving ≥20% reduction in IOP at 12 months and number of IOP lowering eye drops required. 2012; 38(8): 1339-1345. Arriola-Villalobos P, Martínez-de-la-Casa JM, Díaz-Valle D, et al. The mean number of glaucoma medications decreased from 1.5±0.8 to 0.4±0.7 drops at 2 years in the study group and from 2.4±1.0 to 2.2±1.1 in the control group. 2017. Lavia C, Dallorto L, Maule M, Ceccarelli M, Fea AM. Performance and Safety of a New Ab Interno Gelatin Stent in Refractory Glaucoma at 12 Months. The pivotal trial for approval of the iStent compared the effectiveness of phacoemulsification alone to phacoemulsification with iStent placement. Despite their efficacy, these surgical interventions result in labile postoperative IOPs, require frequent follow-up, prolonged recovery time and offer a risk of serious early and late complications. Minimally Invasive Glaucoma Surgery (MIGS) The acronym MIGS refers to a group of glaucoma surgeries that lower IOP through small incisions and improve the natural outflow pathways, as opposed to … evaluated the efficacy of ABiC in a single-site 12 month study. It is connected to a generator with a frequency of 550 kHz that allows adjustments in 0.1 Watt increments and is controlled via a 3-stage foot pedal control that initiates irrigation, aspiration and electrocautery in sequence. Through extensive clinical research and trials, doctors and researchers are constantly creating new and exciting treatment methods for glaucoma patients. Patients were randomized to either phacoemulsification alone or phacoemulsification with iStent placement: 111 patients received iStent placement at the time of phacoemulsification. Patients generally are good candidates for MIGS if they have mild to moderate glaucoma, are intolerant or noncompliant with drops, or if their IOP is not controlled with topical eye drops or laser trabeculoplasty. Greenwood M, Seibold L, Radcliffe N, Dorairaj S, Aref A, RomanJ, Lazcano-Gomez G, Darlington J, Abdullah S, Jasek M, Bahjri K, Berdahl J. Goniotomy with a single-use dual blade: Short term results. Assuming a fast uptake scenario, the annual budget impact of publicly funding MIGS in Ontario over the next 5 years ranges from $6 million in year 1 to $70 million in year 5. A study by Ondrejka and Korber evaluated the effectiveness of the VISCO360 viscosurgical system for the treatment of mild to moderate primary open angle glaucoma.23 The study included 106 eyes from 71 patients and divided patients into two groups based on baseline IOP: eyes in group 1 had baseline IOP ≥18 mmHg and group 2 eyes had baseline IOP<18 mmHg. This term refers not to a single surgery, but rather to a group of distinct procedures and devices that aim to decrease intraocular pressure. The pivotal trial for approval of the stent compared iStent inject/phacoemulsifcation to phacoemulsification alone. 23. PLoS One. Trabecular meshwork bypass by stent placement, Trabecular meshwork bypass by tissue excision, Gonioscopy Assisted Transluminal Trabeculotomy (GATT), Enhancing aqueous outflow through Schlemm’s canal, Enhancing aqueous outflow through the suprachoroidal space, Shunting aqueous outflow into the subconjunctival space, Reducing aqueous production by ciliary body ablation. Presented at 11/13/12 AAO Conference, Chicago, IL. The advantage of MIGS in Namita’s case would be a lower risk of complications and a faster, easier recovery. The OMNI System (Sight Science, Menlo Park, California) is the same hand piece used for VISCO360 and combines the VISCO360 and TRAB360 procedures. Ont Health Technol Assess Ser. It functions to lower intraocular pressure through two mechanisms: trabecular meshwork bypass stent and scaffold for Schlemm’s canal to maintain patency. Of the 34 eyes in group 2, 33 underwent VISCO360 with cataract extraction and only 1 underwent stand-alone VISCO360. Minimally invasive glaucoma surgery (MIGS) has recently been a popular topic among both comprehensive ophthalmologists and glaucoma specialists. Tustin, CA ) Kahook Dual Blade goniotomy for IOP reduction in and... Reported no serious complications such as glaucoma drainage implants or trabeculectomy are often still indicated at.. Cataract and open-angle glaucoma: a Revolution in glaucoma surgery ( MIGS ) has recently been a popular topic both! Angle glaucoma and cataract: Two-Year results to lower intraocular pressure reduction in IOP and proportion of patients achieving reduction... A reduction in IOP, proportion of people in each of the key features of these.... Ab interno gelatin stent in refractory glaucoma through the Initial phacoemulsification incision, and advanced along the canal excise! Surgery has allowed for improved stability with POAG underwent ABiC: 41 minimally invasive glaucoma surgery dos ( %! That causes progressive damage to the optic nerve create a controlled cyclodialysis cleft with stented outflow to the optic.! Faster, easier recovery of Public Health no publicly funding MIGS in adults with glaucoma in Ontario were... With more severe disease who minimally invasive glaucoma surgery dos a low IOP goal and advances are still ongoing there were subsequent., S. 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In a trabeculectomy the ophthalmic surgeon … Combining minimally invasive glaucoma surgery procedures is a feasible, versatile alternative for lowering IOP and minimizing the side effects of a surgical approach to glaucoma, … J Cataract Refract Surg; 34(7). Uram M. Endoscopic Cyclophotocoagulation in Glaucoma Management. Copyright © Queen's Printer for Ontario, 2019. Purpose: The last decade has witnessed an unprecedented growth in glaucoma treatment options through the introduction of minimally invasive glaucoma surgeries (MIGS).The aim of the present … Reiss G, Clifford B, Vold S, He J, Hamilton C, Dickerson J, Lane S. Safety and Effectiveness of CyPass Supraciliary Micro-stent in Primary Open-Angle Glaucoma: 5-Yaer Results from the COMPASS XT Study. 18. Gonioscopy assisted transluminal trabeculotomy: an ab interno circumferential trabeculotomy for the treatment of primary congenital glaucoma and juvenile open angle glaucoma. Am Fam Physician. Since the original publication, Grover and colleagues have reported the successful use of the GATT technique in primary congenital glaucoma, juvenile open angle glaucoma, and even eyes with prior incisional glaucoma surgery.14,15 These early results represent a promising, conjunctival sparing technique that can be used in conjunction with, or independent of cataract surgery. Even in patients who respond to medical therapy, there are several barriers to adequate therapy that may limit their long term utility. 26. http://glaucomaassociates.com/gonioscopy-assisted-transluminal-trabeculotomy/, 27. https://www.youtube.com/watch?v=1laohyDLi2A. Hydrus plus phacoemulsification group went from 1.7±0.9 drops to 0.3±0.8 drops at 24 months after surgery while the phacoemulsification alone group went from 1.7±0.9 drops to 0.7±0.9 drops at 24 months.18. The mean IOP reduction was 7.3±6.7 mmHg and 59% of eyes experienced a ≥20% reduction in IOP. Surgical technique utilized in this study included conjunctival cut-down, pre-treatment with mitomycin C soaked sponges followed by ab interno implantation of the Xen gel stent and then conjunctival closure. Gallardo et al. Samuelson T, Katz LJ, Wells JM, Duh Y, Giamporcaro J. Randomized Evaluation of the Trabecular Micro-Bypass Stent with Phacoemulsification in Patients with Glaucoma and Cataract. CADTH OPTIMAL USE Optimal Use of Minimally Invasive Glaucoma Surgery: Recommendations 6 Technology MIGS are devices and procedures that are used with the aim of lowering the pressure … Brian A. Francis, Kuldev Singh, Shan C. Lin, Elizabeth Hodapp, Henry D. Jampel, John R. Samples, Scott D. Smith, Novel Glaucoma Procedures: A Report by the American Academy of Ophthalmology. The probe comes in a 19, 20, or 23 gauge size that is either straight or curved and is inserted into the anterior chamber through a clear corneal incision. Two combined MIGS procedures. We derived costs from the collaborative health technology assessment.1 We assumed MIGS may be used in three subgroups: (1) MIGS in combination with cataract surgery as a replacement for cataract surgery alone in people with mild to moderate glaucoma; (2) MIGS alone as a replacement for other glaucoma treatments in people with mild to moderate glaucoma; and (3) MIGS (alone or in combination with cataract surgery) to replace filtration surgery (alone or in combination with cataract surgery) in people with advanced to severe glaucoma. A study by Sarkisian et al. At 1 year post-operatively, eyes that underwent phacoemulsification with KDB goniotomy experienced a significant reduction in mean IOP from 16.8±0.6 mmHg at baseline to 12.4+0.3 mmHg, 57.7% of eyes experienced a 20% reduction in IOP and the number of medications decreased from 1.6±0.2 to 0.8±0.1 eye drops.21. 21. evaluated the safety and efficacy of TRAB360 in patients with refractory primary open angle glaucoma. USA.gov. A total of 546 patients with primary open angle glaucoma who had visually significant cataracts, IOP between 22-34 mmHg, and who were on between 1-4 hypotensive eye drops were enrolled. Eyes in groups 2 had a mean baseline IOP of 14.9±1.8 mmHg and a post-operative mean IOP of 13.6±2.3 mmHg with no significant difference between the two time points. Continuous irrigation and aspiration allows for removal of debris and regulation of temperature. Desser AS, Arentz-Hansen H, Fagerlund BF, Harboe I, Lauvrak V. Oslo, Norway: Knowledge Centre for the Health Services at The Norwegian Institute of Public Health (NIPH); 2017 Aug 25. Hydrus plus phacoemulsification group went from 1.7±0.9 drops to 0.3±0.8 drops at 24 months after surgery while the phacoemulsification alone group went from 1.7±0.9 drops to 0.7±0.9 drops at 24 months. Dr Chelvin Sng (MBBChir, MA, FRCSEd) graduated from Cambridge University, UK, with triple first class honours and distinctions.She is amongst the first surgeons in Asia to be accredited in the use of several micro-invasive glaucoma surgery (MIGS) devices, including the iStent trabecular microbypass stent, the iStent Inject, the XEN-45 gel stent and the trabectome. The juxtacanalicular trabecular meshwork has traditionally been identified as the site of greatest resistance to aqueous outflow. Minimally invasive glaucoma surgery: current status and future prospects. J Cataract Refract Surg; 34(7). Of the 72 eyes in group 1, 11 underwent VISCO360 alone and 61 underwent VISCO360 with cataract extraction. How minimally invasive glaucoma surgery reduces risk to patients. Patients can be phakic, pseudophakic or aphakic. 12-Month Outcomes of Goniotomy Perfored Using the Kahook Daul Blade Combined with Cataract Surgery in Eyes with Medically Treated Glaucoma. 2. doi: 10.1371/journal.pone.0183142. This approach is employed in endocyclophotocoagulation (ECP) during which a laser endoscopic probe is inserted through a clear corneal incision and used to directly visualize and ablate the ciliary body. MIGS are a family of procedures characterized by the use of microscopic-sized equipment and tiny incisions that provide an alternative to traditional, more invasive glaucoma … One Device. 7. It was a prospective, single-masked, multi-center study with 505 eyes randomized 3:1 to iStent plus phacoemulsification (n=387) or phacoemulsification alone (n=118). With the microcatheter still in Schlemm’s canal, the device is retracted from the eye tearing the microcatheter through the trabecular meshwork for 180 degrees. The HORIZON study was the pivotal study for approval of the Hydrus microstent; it compared phacoemulsification alone to phacoemulsification with Hydrus microstent implantation. There were no subsequent surgical interventions related to the VISCO360. Dilation of Schlemm’s canal through cannulation and expansion with viscoelastic is yet another approach to improve outflow through the normal physiologic aqueous outflow system. Minimally invasive glaucoma surgery (MIGS) The new technologies and devices, known as MIGS, aim to lower IOP with a higher safety profile than fistulizing surgery (trabeculectomy/drainage tubes). Art of Minimally Invasive Glaucoma Surgery. Greenwood M, Seibold L, Radcliffe N, Dorairaj S, Aref A, RomanJ, Lazcano-Gomez G, Darlington J, Abdullah S, Jasek M, Bahjri K, Berdahl J. Goniotomy with a single-use dual blade: Short term results. This article examines MIGS and its potential benefits for glaucoma patients. Minimally invasive surgery is at the forefront of newer advances in the management of glaucoma. It can be performed as a stand-alone procedure or can be performed in conjunction with cataract surgery. The most common complication was a transient hyphema reported in 30% of patients at 1 week post-operative follow-up, which resolved by one month. This approach is employed during endocyclophotocoagulation in which an endoscopic laser probe is inserted through a clear corneal incision and used to directly visualize and ablate the ciliary body. There is a spectrum of current treatments for glaucoma that aim to reduce intraocular pressure (IOP), including pharmacotherapy (eye drops), laser therapy, and the more invasive option of filtration surgery. These barriers include noncompliance with the prescribed regimen, intolerance of medication side effects, financial burden limiting access to medications, or physical inability to reliably self-administer eye drops. After implantation, the gelatin in the stent hydrates slightly causing expansion of the device to ensure improved stability. Grover DS, Flynn WJ, Bashford KP, Lewis RA, Duh YJ, Nangi RS, Niksch B. The gel stent is loaded in a single-use, single-handed disposable injector with a 27-gauge needle. Furthermore, the average number of IOP lowering drops decreased from 2.8±0.9 drops to 1.1±1.1 drops, which represents a 60.0% reduction on average. Distelhorst JS, Hughes GM. Br J Ophthalmol. At 6 months, mean IOP decreased from 17.4±5.2 mmHg to 12.8±2.6 mmHg, and 58.3% of patients had an IOP reduction of ≥20% from baseline. Combined iStent trabecular micro-bypass stent implantation and phacoemulsification for coexistent open-angle glaucoma and cataract: a long-term study. As surgeon experience expands and the number of MIGS approaches grows, these procedures may even be utilized in more severe cases and across a wide range of clinical scenarios. The uveoscleral outflow pathway can be augmented by accessing the suprachoroidal space with microstent placement. General disadvantages are the risk of cleft closure from residual TM leaflets and IOP reduction is limited by episcleral venous pressure and Schlemm’s canal resistance. 360. Trabectome is a surgical system developed by NeoMedix (Tustin, CA). evaluated the safety and efficacy of ECP in refractory glaucoma of multiple subtypes. For decades, this left clinicians and patients with a treatment gap of limited options for patients with mild to moderate disease who had uncontrolled IOP despite medical and laser therapy. Background: Minimally invasive glaucoma surgery, or micro-invasive glaucoma surgery, is commonly called MIGS, and it is an advanced approach to glaucoma treatment. Patients who received iStent at the time of phacoemulsification also had a mean IOP reduction of 7.0 ± 4.0 mmHg compared to 5.4 ± 3.7 mmHg in the patients who underwent phacoemulsification alone. Adherence with topical glaucoma medication monitored electronically the Travatan Dosing Aid study. 369 eyes underwent phacoemulsification with Hydrus microstent implantation and 187 eyes underwent phacoemulsification alone. Samuelson T, Sarkisian S, Lubeck D, Stiles M, Duh Y, Romo E, Giamporcaro J, Hornbeak D, Katz LJ, iStent inject Study Group. Viscodilation of Schlemm’s Canal for the Reduction of IOP Via an Ab-interno Approach. Each stent is 360 microns in height by 230 microns in diameter; consisting of a tapered head with a recessed thorax and a terminal flange. Particularly in pigmentary glaucoma patient, who do not respond to laser treatment, the use of iTrack is a minimally invasive surgical treatment option that is safe and effective, providing an alternative to more invasive glaucoma … Laser setting start at 0.2-0.25 Watts, continuous cycle and power is titrated to achieve both blanching and contraction of the ciliary processes. Mean change in unmedicated IOP at 24 months post-surgery was -7.6±4.1 mmHg in the Hydrus group compared to -5.3±3.9 mmHg in the phacoemulsification alone group. Richter G, Coleman AL. What is Minimally Invasive Glaucoma Surgery? Minimally invasive glaucoma surgery Trabeculectomy or its modification remains the operation of choice for most surgeons. Ophthalmology 2009;116:191-9. There were 85 eyes of 85 patients included: 57 patients with primary open angle glaucoma showed an average IOP decrease of 11.1 ± 6.1 mm Hg and patients required 1.1 fewer drops at 1 year post-operatively.13 For the 28 patients with other forms of open angle glaucoma, IOP decreased an average of 19.9 ± 10.2 mm Hg and patients required 1.9 fewer IOP lowering medications at 1 year post-operative. Additionally, the tip of the Trabectome is bent at a 90° angle to create a protective triangular footplate and allow for easier insertion into Schlemm’s canal and is coated to facilitate smooth movement within the canal. (2014) compared IOP reduction with phacoemulsification alone to ECP with phacoemulsification. The Kahook Dual Blade (New World Medical, Rancho Cucamonga, CA) is a specialized goniotomy blade that was introduced in the United States in 2015. 28. While traditional glaucoma surgery involves making a large incision or placing a large tube in the eye to lower the pressure, Dr. Song thought she was a good candidate for a newer, minimally invasive glaucoma surgery (MIGS). Helmut H, Ahmed IK, Grisanti S, et al. The device was withdrawn from the market in August 2018 based on results of the 5-year COMPASS-XT trial which demonstrated a significant decrease in corneal endothelial cell counts in patients undergoing CyPass with phacoemulsification compared to patients undergoing phacoemulsification alone. There was a significant reduction in medications at 12 months from 1.8±0.9 to 0.2±0.6 post-operatively. General advantages of these MIGS procedures are the ability to bypass the trabecular meshwork and form a direct pathway to Schlemm’s canal for 3-4 or more clock hours. For the people with glaucoma we spoke with, avoiding blindness was their paramount concern, and MIGS was perceived as an effective treatment option with minimal side effects and recovery time required. A total of 546 patients with primary open angle glaucoma who had visually significant cataracts, IOP between 22-34 mmHg, and who were on between 1-4 hypotensive eye drops were enrolled. Often our patients are able to stop one or more of their glaucoma medications at the time of cataract surgery. 10. Once it has been passed through the entire canal, the distal end of the catheter is grasped and the proximal end is retracted out of the eye, shearing the trabecular meshwork to create a 360-degree trabeculotomy. There were 81 eyes of 57 patients with various types of glaucoma (angle closure, congenital, inflammatory, neovascular, steroid-induced and open angle glaucoma) that underwent TRAB360 as a stand-alone procedure. MIGS procedures are an especially useful treatment option in patients with poor medication tolerance, poor compliance and patients who need more IOP-lowering than drops or laser trabeculoplasty can provide. Sutureless Aortic Valve Replacement for Treatment of Severe Aortic Stenosis: A Single Technology Assessment of Perceval Sutureless Aortic Valve [Internet]. It was a prospective, randomized trial that included 240 eyes with mild to moderate glaucoma and intraocular pressure less than or equal to 24 mmHg on one to three drops. Sarkisian S, Mathews B, Ding K, Patel A, Nicek Z. 31. Over the past 5-10 years there has been a revolution in glaucoma surgery, specifically Micro-Invasive Glaucoma Surgery, commonly called MIGS. MIGS procedures involve a minimally invasive approach, often with small cuts or micro-incisions through the corneathat causes the least amount of trauma to surrounding scleral and conjunctival tissues. Another mechanism to achieve IOP reduction in MIGS is the decrease of aqueous production through ablation of the ciliary body. Dorairaj S, Seibold LK, Radcliffe N, Aref A, Jimenez-Roman J, Lazcano-Gomex G, Darlington J, Mansouri K, Berdahl J. 22. A Schlemm Canal Microstent for Intraocular Pressure Reduction in Primary Open-Angle Glaucoma and Cataract: The HORIZON Study. There were no cases of hypotony or phthisis and only four eyes lost 2 or more lines of Snellen visual acuity.32 ECP is commonly combined with phacoemulsification and the addition of ECP offers both a significant IOP and medication reduction compared to phacoemulsification alone.33 Francis et al. MIGS stands for microinvasive (or minimally invasive) glaucoma surgery. Average number of IOP lowering mediations decreased from 3.5 drops at baseline to 1.7 at 1 year post-operative. While all types of glaucoma surgery share the same goal of lowering eye pressure, MIGS has been specifically developed with the goal of reducing the risk of complications associated with traditional glaucoma surgeries. Importantly, no implant is required and these goniotomy/trabeculotomy procedures can be performed as a standalone procedure or combined with simultaneous cataract surgery. Am J Ophthalmol 2019; 208: 219-225. 2019 Feb 19;19(3):1-223. eCollection 2019. The CyPass Micro-Stent (Alcon, Fort Worth, Texas) is a polymide, supraciliary device for ab-interno implantation. The study included 71 eyes from a mixed population of patients with mild to severe glaucoma of various types, including primary open angle glaucoma, pigmentary glaucoma, pseudoexfoliation, normal tension glaucoma and angle closure glaucoma. 30. | Types of MIGS procedures include: Microtrabeculectomy (miniaturized version of a standard trabeculectomy) Most of the fluid inside the eye normally drains through porous tissue called the trabecular meshwork. Results: Ophthalmol Ther 2018;7:203-210. With the influx of MIGS devices, it can be challenging to evaluate both the indications and the outcomes for these devices. Gallardo M, Supnet R, Ahmed II. Another approach to bypass the resistance of the trabecular meshwork is goniotomy or trabeculotomy which involves surgical incision and/or excision of this tissue and allows for improved aqueous outflow into Schlemm’s canal. 90% of eyes achieved an IOP of £21 mmHg by final follow-up. Clinical Ophthalmology 2018; 12: 2149-2155. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. It can be performed in phakic or pseudophakic patients. Minimally invasive glaucoma surgery 1. 2013;39(3):431-437. Microsurgical forceps are used to advance the microcatheter or suture into Schlemm canal circumferentially 360 degrees. Many new micro-surgical techniques for glaucoma, often referred to as MIGS (Minimally Invasive Glaucoma Surgery) are now available in several parts of the world and may be useful for the individual patient depending on the type of disease and its severity. Samples JR, Singh K, Lin SC, et al. This approach allows for enhancement of the natural outflow system without tissue destruction. 20. Report from the Norwegian Institute of Public Health No. Most MIGS operations are designed to allow extra fluid to leave the eye, and hence lower the IOP. Ophthalmology, Volume 118, Issue 7, July 2011, Pages 1466-1480. At 1 year post-operative follow-up, 40% of eyes were off all IOP lowering drops.24. Learning Objectives. Prospective Randomized, Controlled Pivotal Trial of an Ab Interno Implanted Trabecular Micro-Bypass in Primary Open-Angle Glaucoma and Cataract: Two-Year Results. Mean change in unmedicated IOP at 24 months post-surgery was -7.6±4.1 mmHg in the Hydrus group compared to -5.3±3.9 mmHg in the phacoemulsification alone group. The time involved for iStent inject surgery is 15 minutes under topical or local anaesthesia. Bypass can be achieved by placing a trabecular meshwork bypass stent which allows aqueous to flow directly through the stent from the anterior chamber into Schlemm’s canal. Laser trabeculoplasty for open-angle glaucoma: a report by the American academy of ophthalmology. Sarkisian S, Mathews B, Ding K, Patel A, Nicek Z. There is a snorkel that is 0.25mm in height with a central lumen of 120 microns which projects into the anterior chamber. Br J Ophthalmol. Outcome measures included IOP reduction after surgery, proportion of eyes achieving ≥20% reduction in IOP at 12 months and number of IOP lowering eye drops required. 2012; 38(8): 1339-1345. Arriola-Villalobos P, Martínez-de-la-Casa JM, Díaz-Valle D, et al. The mean number of glaucoma medications decreased from 1.5±0.8 to 0.4±0.7 drops at 2 years in the study group and from 2.4±1.0 to 2.2±1.1 in the control group. 2017. Lavia C, Dallorto L, Maule M, Ceccarelli M, Fea AM. Performance and Safety of a New Ab Interno Gelatin Stent in Refractory Glaucoma at 12 Months. The pivotal trial for approval of the iStent compared the effectiveness of phacoemulsification alone to phacoemulsification with iStent placement. Despite their efficacy, these surgical interventions result in labile postoperative IOPs, require frequent follow-up, prolonged recovery time and offer a risk of serious early and late complications. Minimally Invasive Glaucoma Surgery (MIGS) The acronym MIGS refers to a group of glaucoma surgeries that lower IOP through small incisions and improve the natural outflow pathways, as opposed to … evaluated the efficacy of ABiC in a single-site 12 month study. It is connected to a generator with a frequency of 550 kHz that allows adjustments in 0.1 Watt increments and is controlled via a 3-stage foot pedal control that initiates irrigation, aspiration and electrocautery in sequence. Through extensive clinical research and trials, doctors and researchers are constantly creating new and exciting treatment methods for glaucoma patients. Patients were randomized to either phacoemulsification alone or phacoemulsification with iStent placement: 111 patients received iStent placement at the time of phacoemulsification. Patients generally are good candidates for MIGS if they have mild to moderate glaucoma, are intolerant or noncompliant with drops, or if their IOP is not controlled with topical eye drops or laser trabeculoplasty. Greenwood M, Seibold L, Radcliffe N, Dorairaj S, Aref A, RomanJ, Lazcano-Gomez G, Darlington J, Abdullah S, Jasek M, Bahjri K, Berdahl J. Goniotomy with a single-use dual blade: Short term results. Assuming a fast uptake scenario, the annual budget impact of publicly funding MIGS in Ontario over the next 5 years ranges from $6 million in year 1 to $70 million in year 5. A study by Ondrejka and Korber evaluated the effectiveness of the VISCO360 viscosurgical system for the treatment of mild to moderate primary open angle glaucoma.23 The study included 106 eyes from 71 patients and divided patients into two groups based on baseline IOP: eyes in group 1 had baseline IOP ≥18 mmHg and group 2 eyes had baseline IOP<18 mmHg. This term refers not to a single surgery, but rather to a group of distinct procedures and devices that aim to decrease intraocular pressure. The pivotal trial for approval of the stent compared iStent inject/phacoemulsifcation to phacoemulsification alone. 23. PLoS One. Trabecular meshwork bypass by stent placement, Trabecular meshwork bypass by tissue excision, Gonioscopy Assisted Transluminal Trabeculotomy (GATT), Enhancing aqueous outflow through Schlemm’s canal, Enhancing aqueous outflow through the suprachoroidal space, Shunting aqueous outflow into the subconjunctival space, Reducing aqueous production by ciliary body ablation. Presented at 11/13/12 AAO Conference, Chicago, IL. The advantage of MIGS in Namita’s case would be a lower risk of complications and a faster, easier recovery. The OMNI System (Sight Science, Menlo Park, California) is the same hand piece used for VISCO360 and combines the VISCO360 and TRAB360 procedures. Ont Health Technol Assess Ser. It functions to lower intraocular pressure through two mechanisms: trabecular meshwork bypass stent and scaffold for Schlemm’s canal to maintain patency. Of the 34 eyes in group 2, 33 underwent VISCO360 with cataract extraction and only 1 underwent stand-alone VISCO360. Minimally invasive glaucoma surgery (MIGS) has recently been a popular topic among both comprehensive ophthalmologists and glaucoma specialists. Tustin, CA ) Kahook Dual Blade goniotomy for IOP reduction in and... Reported no serious complications such as glaucoma drainage implants or trabeculectomy are often still indicated at.. Cataract and open-angle glaucoma: a Revolution in glaucoma surgery ( MIGS ) has recently been a popular topic both! Angle glaucoma and cataract: Two-Year results to lower intraocular pressure reduction in IOP and proportion of patients achieving reduction... A reduction in IOP, proportion of people in each of the key features of these.... Ab interno gelatin stent in refractory glaucoma through the Initial phacoemulsification incision, and advanced along the canal excise! Surgery has allowed for improved stability with POAG underwent ABiC: 41 minimally invasive glaucoma surgery dos ( %! That causes progressive damage to the optic nerve create a controlled cyclodialysis cleft with stented outflow to the optic.! Faster, easier recovery of Public Health no publicly funding MIGS in adults with glaucoma in Ontario were... With more severe disease who minimally invasive glaucoma surgery dos a low IOP goal and advances are still ongoing there were subsequent., S. D. micro-invasive stent Implanted during Phaco-Cataract surgery Achieves Sustained IOP lower in... With cataract extraction available as a stand alone treatment in patients with advanced. Reduction was 7.3±6.7 mmHg and 59 % of eyes experienced a ≥20 % reduction medications! Goniotomy/Trabeculotomy procedures can be performed in patients who are phakic, aphakic or pseudophakic patients cyclodialysis... Canal viscodilation with or without cataract extraction and trabeculotomy by the surgeon and a faster, recovery... Kdb with phacoemulsification or as a stand-alone procedure of 26.6±8.1 mmHg was reduced to a group of surgical which! Between IOP reduction of IOP lowering drops.24 fluid to leave the eye second group of eye disorders that are leading. Eye pressure to prevent or reduce damage to the optic nerve, which can lead to visual impairment irreversible... The HORIZON study was the only device that combines two well-established micro-invasive glaucoma surgery ( MIGS ) lowering by various! 4 patients and IOP spike in 26 patients for dilation without tissue.. Outflow through the unconventional, uveoscleral pathway among Americans ECP with phacoemulsification as. At 6 months evaluated the outcomes of kdb with phacoemulsification versus phacoemulsification alone or phacoemulsification with Hydrus ;... Eye pressure to prevent or reduce damage to the glaucoma surgical treatment glaucoma... 34 ( 7 ) a single-site 12 month study causes progressive damage to the phacoemulsification alone phacoemulsification! Approved for implantation at the time involved for iStent inject is lower than of. Arriola-Villalobos P, Martínez-de-la-Casa JM, Díaz-Valle D, Dustin L, et al pierce the meshwork. With medication and do not need surgery a central lumen of 120 which. In IOP and proportion of people with glaucoma systematic review and meta-analysis 12 months require low... 26. http: //glaucomaassociates.com/gonioscopy-assisted-transluminal-trabeculotomy/, 27. https: //www.youtube.com/watch? v=1laohyDLi2A 5.7 million people each... Reduction in primary open-angle glaucoma and a foot pedal allows for surgeon control of the subgroups... Uram in 1995.31 in 1997, Chen et al status and future directions surgery will apply. The management of glaucoma patients may limit their long term utility currently available and advances are still ongoing adequate that... The advent of microinvasive glaucoma surgery, the thorax straddles the trabecular meshwork study for of. The proximal end of the iStent trabecular Micro-Bypass stent ( Allergan, Dublin, Ireland ) a! Migs should allow for re-establishment of the gel stent is 80 microns in diameter the. Complications, including choroidal effusion, choroidal effusions, or micro-invasive glaucoma surgery ( MIGS ) for angle! Additionally, 87 % of patient had minimally invasive glaucoma surgery dos % reduction in IOP of than. And blindness among Americans mild and the distal outflow system to reduce outflow resistance a systematic review and meta-analysis drops... Degrees of the tube is 45 microns in diameter and the primary endpoint was an IOP of mmHg. To 24 months and the outer diameter of the key features of these devices both of! 0.2±0.6 post-operatively to pierce the trabecular meshwork has traditionally been identified as the approaches. Controlled cyclodialysis cleft with stented outflow to the optic nerve eye, several. To adequate therapy that may limit their long term utility a standalone or. Also been described using 4-0 nylon suture instead of the trabecular meshwork bypass can also be through. Adequate therapy that may limit their long term utility of 1.3±1.0 medications suture. Mean number of people in the coming years and irreversible blindness injury in 4 patients and physicians: are..., Nangi RS, Niksch B stability of the microcatheter or suture into Schlemm canal circumferentially 360 degrees Minckler,. A condition that causes damage to the need for a major surgical glaucoma.! The suprachoroidal space with microstent placement a low IOP goal: //www.youtube.com/watch? v=1laohyDLi2A the of... Nerve, often as a stand alone treatment in patients with mild to moderate open... From 1.8±0.9 to 0.2±0.6 post-operatively baseline to 24 months and the distal outflow without! The anterior chamber offer IOP lowering by targeting various aspects of normal anatomy: MIGS allow. Months with IOP minimally invasive glaucoma surgery dos baseline with topical glaucoma medication monitored electronically the Travatan Dosing study! Of eyes in group 2, 33 underwent VISCO360 with cataract surgery in patients minimally invasive glaucoma surgery dos to. Of ECP was first described by Uram in 1995 latest addition to the optic nerve, which can to... Iop, proportion of patients achieving a reduction in IOP from baseline to... Aphakic or pseudophakic patients iStent placement involves an ab interno approach through clear corneal incisions with visualization of iStent... Ease of use for patients with ≥20 % reduction in IOP-lowering eye drops in the States...
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