21. Br J Ophthalmol. Ophthalmology 2011; 118: 459-467. Gallardo M, Supnet R, Ahmed II. 6. The pivotal trial for approval of the stent compared iStent inject/phacoemulsifcation to phacoemulsification alone. Baseline IOP of patients in the phacoemulsification/Cypass group was 24.2±2.8 mmHg with an average of 1.4±0.9 medications. Ont Health Technol Assess Ser. This is an excellent alternative to invasive filtering surgery in patients with mild, moderate or severe glaucoma. Additionally, 77% of patients in the stent group had ≥20% reduction in IOP compared to 60% in the phacoemulsification only group. The device is a heparin-coated, non-ferromagnetic titanium stent. Conclusions: The juxtacanalicular trabecular meshwork has traditionally been identified as the site of greatest resistance to aqueous outflow. 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. Ophthalmology 2009;116:191-9. Am J Ophthalmolo 2017; 183: 25-36. The first approaches involve enhancing outflow across the trabecular meshwork and through Schlemm’s canal. The procedures increase glaucoma control and eliminate the need for a major surgical glaucoma procedure. There are now several types of surgeries that fit in the MIGS category and many of them are used in conjunction with cataract surgery. At 1 year post-operative follow-up, 40% of eyes were off all IOP lowering drops.24. At 1 year post-op, only 41 eyes (51%) were available for analysis. Please enable it to take advantage of the complete set of features! 7. Pfeiffer N, Lorenz K, Ramirez M, et al. 2. MIGS procedures constitute a group of surgical interventions which share five characteristics. 14. The number of people with glaucoma worldwide in 2010 and 2020. Ophthalmology Jun 2019; 126(6): 811-821. 2.2. Another mechanism to achieve IOP reduction in MIGS is the decrease of aqueous production through ablation of the ciliary body. Bloom P, Au L. “Minimally invasive glaucoma surgery (MIGS) is a poor substitute for trabeculectomy”—The great debate. Micro- or minimally invasive glaucoma surgeries (MIGS) have been the latest addition to the glaucoma surgical treatment paradigm. See this image and copyright information in PMC. 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. 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. Most adverse events were mild and the most common included the need for needling, transient decrease in visual acuity and transient hypotony.30. 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 … We completed this work to complement a health technology assessment conducted in collaboration with the Canadian Agency for Drugs and Technologies in Health (CADTH). The device measures 0.3mm in height and 1mm in length. Open-angle glaucoma. In these patients, mean IOP decreased from 27.7±10.3 mmHg pre-operatively to 17.0±6.7 mmHg at final post-operative time point (average 12.9 months). A study by Sarkisian et al. 20. This resistance can be overcome through bypassing or removing this tissue to lower IOP through increased outflow. 16. Performance and Safety of a New Ab Interno Gelatin Stent in Refractory Glaucoma at 12 Months. Patients were randomized to either phacoemulsification alone or phacoemulsification with iStent placement: 111 patients received iStent placement at the time of phacoemulsification. The Academy uses cookies to analyze performance and provide relevant personalized content to users of our website. 18. Ophthalmology. Combined cataract extraction and trabeculotomy by the internal approach for coexisting cataract and open-angle glaucoma: Initial results. There was also a significantly greater reduction in hypotensive eye drops in the Hydrus group compared to the phacoemulsification alone groups. Minimally invasive glaucoma surgery (MIGS) is one of the new and exciting developments in the treatment of glaucoma. We analyzed the budget impact of publicly funding MIGS in adults with glaucoma in Ontario. High safety profile: MIGS carry a much lower risk of serious complications such as hypotony, choroidal effusions, or choroidal hemorrhages. This page was last modified on December 3, 2020, at 08:53. However the usual complications which are associated with cataract surgery will still apply if a combined procedure is performed. 1096-1103. Further, 85% of eyes in the Cypass group were drop free at 2 years.29. Treatment failure occurred in 8/85 patients (9%) due to the need for subsequent glaucoma surgery. 2017-01. 13. 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. 5 Okeke CO, Quigley HA, Jampel HD, et al. 3. 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. Treatment typically consists of 200-360 degrees of the angle. The pivotal trial for approval of the iStent compared the effectiveness of phacoemulsification alone to phacoemulsification with iStent placement. There was no significant difference between IOP reduction in eyes that underwent stand-alone ABiC versus eyes that underwent combined ABiC/phacoemulsification. Glaucoma refers to a group of eye disorders that are a leading cause of vision loss and blindness among Americans. 1. J Cataract Refract Surg; 34(7). Minimally-invasive glaucoma surgeries (MIGS) for open angle glaucoma: A systematic review and meta-analysis. 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. After making a nasal goniotomy, the catheter is advanced 360 degrees into Schlemm’s canal and slowly withdrawn while performing viscodilation of the canal and the distal outflow system. The guide wire is used to perform blunt dissection of the ciliary body in order to allow passage into the supraciliary space where the stent can be placed. 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. After implantation, the gelatin in the stent hydrates slightly causing expansion of the device to ensure improved stability. It can be performed as a stand-alone procedure or in combination with cataract surgery. E. Randy Craven, L. Jay Katz, Jeffrey M. Wells, Jane Ellen Giamporcaro, iStent Study Group, Cataract surgery with trabecular micro-bypass stent implantation in patients with mild-to-moderate open-angle glaucoma and cataract: Two-year follow-up. 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. There was a significant reduction in medications at 12 months from 1.8±0.9 to 0.2±0.6 post-operatively. 19. Ondrejka S and Korber N. 360o ab-interno Schlemm’s canal viscodilation in primary open angle glaucoma. Sarkisian S, Mathews B, Ding K, Patel A, Nicek Z. MIGS comprises a group of surgical procedures which share common features. American Glaucoma Society Annual Meeting. The time involved for iStent inject surgery is 15 minutes under topical or local anaesthesia. Micro-invasive glaucoma surgery (MIGS) is the latest advance in surgical treatment for glaucoma, which aims to reduce intraocular pressure by either increasing outflow of aqueous humor or reducing its production. The COMPASS trial reported on the two year safety and efficacy outcomes for Cypass. Both groups underwent canal viscodilation with or without cataract extraction. In both groups, there was an excellent safety profile with only 14 eyes experiencing a hyphema, most of which were sub-millimeter in size. The device is then rotated and reinserted and the procedure is repeated for the remaining 180 degrees of the angle to accomplish a full 360 degree treatment. Furthermore, it is believed to decrease herniation of the inner wall of Schlemm’s canal into the distal collector channels to improve outflow. Prospective Randomized, Controlled Pivotal Trial of an Ab Interno Implanted Trabecular Micro-Bypass in Primary Open-Angle Glaucoma and Cataract: Two-Year Results. 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. 2019 Feb 19;19(3):1-223. eCollection 2019. Samples JR, Singh K, Lin SC, et al. The device spans 90 degrees of the trabecular meshwork. Background: Glaucoma is a condition that causes progressive damage to the optic nerve, which can lead to visual impairment and irreversible blindness. 369 eyes underwent phacoemulsification with Hydrus microstent implantation and 187 eyes underwent phacoemulsification alone. Outcomes of Gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with prior incisional glaucoma surgery. The advent of microinvasive glaucoma surgery has allowed for improved management of patients with mild to moderate glaucoma. It can be performed in conjunction with phacoemulsification or as a stand-alone procedure in phakic or pseudophakic patients. Alternatively, patients who do not experience an IOP decrease should attain the reduction of at least one medication. A Schlemm Canal Microstent for Intraocular Pressure Reduction in Primary Open-Angle Glaucoma and Cataract: The HORIZON Study. [4] As an alternative to traditional glaucoma treatments, minimally invasive glaucoma surgery (MIGS) has shown promise for the future management of glaucoma… Current Opin Ophthalmol 1995; 6(2): 19-29. The uveoscleral outflow pathway can be augmented by accessing the suprachoroidal space with microstent placement. Dorairaj S, Seibold LK, Radcliffe N, Aref A, Jimenez-Roman J, Lazcano-Gomex G, Darlington J, Mansouri K, Berdahl J. The procedure allows for dilation without tissue destruction of the natural drainage system. Minimally invasive glaucoma surgery Trabeculectomy or its modification remains the operation of choice for most surgeons. To meet this clinical need, a number of devices have recently been developed labeled as either micro‐incision or minimally invasive glaucoma surgery (MIGS) devices that modulate aqueous humor outflow facility via one of several routes (Figure 2). This approach allows for enhancement of the natural outflow system without tissue destruction. 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. 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. Average IOP reduction at 12 months post-op was 32.3% in both groups; 32.8% in the stand-alone ABiC group and 31.7% in the ABiC/phacoemulsification group. 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. Patients were followed out to 12 months and the primary endpoint was an IOP ≤21 mmHg without ocular hypotensive medications. The number of hypotensive eye drops decreased from 1.6±1.3 to 0.9±1.0 eye drops.20  Another study included 52 eyes of patients with open angle glaucoma and visually significant cataracts who underwent phacoemulsification with KDB goniotomy. Grover DS, Flynn WJ, Bashford KP, Lewis RA, Duh YJ, Nangi RS, Niksch B. Included patients had a diagnosis of mild to moderate primary open angle glaucoma, were on up to three pressure lowering drops, had a pre-operative intraocular pressure of less than or equal to 24 mmHg and required cataract surgery. 9. It functions to lower intraocular pressure through two mechanisms: trabecular meshwork bypass stent and scaffold for Schlemm’s canal to maintain patency. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. Through extensive clinical research and trials, doctors and researchers are constantly creating new and exciting treatment methods for glaucoma patients. NIH It can be done at the same time as cataract surgery (a surgery to remove a cloudy eye lens), and may be safer than more invasive surgeries for glaucoma. Treatments are adjusted based on the progression of the disease. It can be performed in patients who are phakic, pseudophakic or aphakic. It can be performed in phakic or pseudophakic patients. The technique of ECP was first described by Uram in 1995.31 In 1997, Chen et al. Structured Education and Neuromuscular Exercise Program for Hip and/or Knee Osteoarthritis: A Health Technology Assessment. Combined cataract extraction and trabeculotomy by the internal approach for coexisting cataract and open-angle glaucoma: Initial results. 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. The HORIZON study was the pivotal study for approval of the Hydrus microstent; it compared phacoemulsification alone to phacoemulsification with Hydrus microstent implantation. In addition to the above mentioned stents, trabecular meshwork bypass can also be achieved through surgical incision/excision of the trabecular meshwork tissue. 33. Francis BA, Minckler D, Dustin L, et al. J Cataract Refract Surg 2014; 40: 1313-1321. MINIMALLY INVASIVE GLAUCOMA SURGERY (MIGS) Glaucoma is an eye condition where the optic nerve which transmits the images we see from our eye to our brain becomes compromised, due to a build-up of pressure inside the eye. Minimally invasive (also known as micro-invasive or micro-bypass) glaucoma surgery refers to a class of surgical treatment used to manage mild-to-moderate cases of primary open-angle glaucoma. Saheb H and Ahmed I. Micro-invasive glaucoma surgery: current perspectives and future directions. Samuelson T, Sarkisian S, Lubeck D, Stiles M, Duh Y, Romo E, Giamporcaro J, Hornbeak D, Katz LJ, iStent inject Study Group. 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 OMNI System (Sight Science, Menlo Park, California) is the same hand piece used for VISCO360 and combines the VISCO360 and TRAB360 procedures. Distelhorst JS, Hughes GM. New York, NY. 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. The device is indicated for the treatment of mild to moderate glaucoma and is approved for implantation at the time of phacoemulsification. According to the Glaucoma Research Foundation, traditional glaucoma surgeries are very effective, but they do carry risks such as … 2012; 38(8): 1339-1345. It can be performed as a stand-alone procedure or can be performed in conjunction with cataract surgery. 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. ECP treatment was performed on 180-360 degrees of the ciliary body. The vast majority of glaucoma patients are controlled with medication and do not need surgery. Furthermore, 84% of eyes that underwent iStent/phacoemulsification were medication free at 23 months compared to 67% of eye that underwent phacoemulsification alone.18. 360o ab-interno trabeculotomy in refractory open-angle glaucoma. A Schlemm Canal Microstent for Intraocular Pressure Reduction in Primary Open-Angle Glaucoma and Cataract: The HORIZON Study. The Kahook Dual Blade (New World Medical, Rancho Cucamonga, CA) is a specialized goniotomy blade that was introduced in the United States in 2015. MIGs utilizing stent placement are discussed below. Other secondary endpoints included mean change in IOP from baseline to 24 months and number of hypotensive medications. The tech… In addition to the above mentioned techniques for bypassing resistance at the level of the trabecular meshwork, other MIGS procedures aim to improve the conventional outflow pathway at the level of Schlemm’s canal and its downstream collector channels. The management of glaucoma is continuously evaluated throughout the life of a glaucoma patient. MIGS procedures can also be used to reduce drop dependence at the time of traditional phacoemulsification surgery in patients whose disease may be well controlled. Vold, S. D. Micro-Invasive Stent Implanted During Phaco-Cataract Surgery Achieves Sustained IOP Lower Effect in Glaucomatous Eyes at 12 Months. March 1-4 2012. These procedures are exciting from a patient’s perspective because they are … These are mentioned below. 20. There was also a significant reduction in IOP lowering drops in group 1 eyes from 2.1±1 to 0.2±0.6 and 85% of eyes required no medications to maintain pre-operative IOP or lower. Maeda M, Watanabe M, Ichikawa K. Evaluation of trabectome in open-angle glaucoma. 369 eyes underwent phacoemulsification with Hydrus microstent implantation and 187 eyes underwent phacoemulsification alone. 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. While the above MIGS approaches augment the conventional outflow pathway, another MIGS approach is to target outflow through the unconventional, uveoscleral pathway. The blade is a single use disposable blade with a sharp tip which is used to pierce the trabecular meshwork, a ramp which stretches the trabecular meshwork and dual parallel blades which create paired parallel incisions in the trabecular meshwork. The iStent inject is the smallest device to be implanted in the human body and, like the first generation iStent, is composed of heparin-coated, non-ferromagnetic titanium. It is called MIGS, the acronym for minimally invasive glaucoma surgery, and it is the biggest development in glaucoma surgical treatment in many years. 22. Pascolini D and Mariotti S. Global estimates of visual impairment: 2010. 2. At 24 months, 75.8% of patients who received iStent inject at the time of cataract surgery had experienced at least a 20% reduction in IOP compared to 61.9% in the phacoemulsification alone group. What is Minimally Invasive Glaucoma Surgery? Minimally invasive glaucoma surgery (MIGS) is the newest group of surgical procedures that aim to reduce pressure in the eye and slow the progression of glaucoma. The VISCO360 device (Sight Sciences, Menlo Park, California) allows for catheterization and viscodilation of Schlemm’s canal. At 24 months, 77.3% of eyes in the Hydrus group experienced at least a 20% reduction in IOP compared to 57.8% of eyes in the phacoemulsification group alone. (2014) compared IOP reduction with phacoemulsification alone to ECP with phacoemulsification. Dr. Aditi Singh Minimally invasive glaucoma surgery (MIGS) 2. Glaucoma is an eye disease that causes damage to the optic nerve, often as a result of high pressure within the eye. TRAB 360 can be performed either in adult or pediatric patients with open angle glaucoma and a clear cornea. 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. 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. 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. The proximal end of the stent has three retention rings to allow for improved stability of the device in the angle. 26. http://glaucomaassociates.com/gonioscopy-assisted-transluminal-trabeculotomy/, 27. https://www.youtube.com/watch?v=1laohyDLi2A. 12-Month Outcomes of Goniotomy Perfored Using the Kahook Daul Blade Combined with Cataract Surgery in Eyes with Medically Treated Glaucoma. MIGS offer IOP lowering by targeting various aspects of normal aqueous dynamics. The study included 80 patients that underwent phacoemulsification (control group) and 80 eyes that underwent phacoemulsification with ECP (study group); baseline IOP was 18.1±3.0 mmHg in both groups. The number of IOP lowering medications decreased from 1.7±1.3 eye drops pre-operatively to 1.1±1.0 eyes drops at 12 months. 2017 Aug 29;12(8):e0183142. Primary outcome measures were reduction in IOP and proportion of patients achieving a reduction in IOP of more than 20% from baseline. Uram M. Endoscopic Cyclophotocoagulation in Glaucoma Management. The mean IOP reduction was 7.3±6.7 mmHg and 59% of eyes experienced a ≥20% reduction in IOP. Early postoperative safety and surgical outcomes after implantation of a suprachoroidal micro-stent for the treatment of open-angle glaucoma concomitant with cataract surgery. Non perforating filtration under a scleral flap and glaucoma … 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. Open angle glaucoma (OAG) is a disease affecting an estimated 2.8 million people in the United States as of 20101, accounting for an approximate cost of $1.5 billion per year.2 Initial therapy for OAG typically consists of medications that can aid in decreasing aqueous humor production or increasing aqueous humor outflow. These procedures work through cannulation and dilation of Schlemm’s canal and the distal outflow system to reduce outflow resistance. 2011; 118(7):2296-2302. This term refers not to a single surgery, but rather to a group of distinct procedures and devices that aim to decrease intraocular pressure. This design allows for complete excision of the trabecular meshwork and reduces the potential for scarring from residual tissue leaflets. MIGS trusitdave 2020-06-20T10:53:38+00:00. Viscodilation of Schlemm’s Canal for the Reduction of IOP Via an Ab-interno Approach. NLM Gonioscopy-assisted transluminal trabeculotomy, ab interno trabeculotomy. There were no subsequent surgical interventions related to the VISCO360. Similar to the TRAB360 device, it is a single-use, single-handed device with a sharp distal tip that is used to pierce the trabecular meshwork and a microcatheter is then advanced through 180 degrees of Schlemm’s canal. eCollection 2017. 33. Of the 72 eyes in group 1, 11 underwent VISCO360 alone and 61 underwent VISCO360 with cataract extraction. 29. Background: Glaucoma is a condition that causes progressive damage to the optic nerve, which can lead to visual impairment and irreversible blindness. The study reported no serious complications, including choroidal effusion, choroidal hemorrhage, or infection. MIGS can be easily incorporated into routine phacoemulsification surgery and can be used in patients who are well-controlled on drops but who desire drop independence. A modified technique has also been described using 4-0 nylon suture instead of the microcatheter. 8. The inner lumen of the tube is 45 microns in diameter and the outer diameter of the gel stent is 150 microns. 15. Introducing a new MIGS billing code may reduce the overall expenditures. It can be performed in patients who are phakic, pseudophakic or aphakic. 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). 19. Several studies have demonstrated the clinical efficacy of Kahook Dual Blade goniotomy for IOP reduction in patients with glaucoma. 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). Patients were followed out to 12 months and the primary endpoint was an IOP ≤21 mmHg without ocular hypotensive medications. 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. The level of IOP reduction is often inferior to traditional filtering surgery but should be at least 20%. Secondary outcome measures included reduction in hypotensive eye drops. Of note, both groups had statistically significant intraocular pressure lowering at 1 year and there was no difference in adverse events between the two groups. These surgical treatment options vary from Minimally Invasive Glaucoma Surgery (MIGS), which is often done in conjunction with cataract surgery, to advanced incisional surgery like implantable tube-shunts and trabeculectomy (lowering eye pressure by creating a small drainage pathway outside of the eye). 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 … evaluated the efficacy of ABiC in a single-site 12 month study. 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. A second group of MIGS approaches seeks to increase outflow via alternate pathways. Clinical Ophthalmology 2019; 13: 1235-1246. Types of MIGS procedures include: Microtrabeculectomy (miniaturized version of a standard trabeculectomy) Francis BA, Berke SJ, Dustin L, Noecker R. Endoscopic cyclophotocoagulation combined with phacoemulsification versus phacoemulsification alone in medically controlled glaucoma. The primary endpoint was the proportion of eyes with unmedicated IOP reduction of greater than or equal to 20% at 24 months after surgery. reported on the 6 and 12 month outcomes of GATT performed in adult patients with open angle glaucoma either in combination with phacoemulsification or as a stand-alone procedure. Vold S, Ahmed II, Craven R, Mattox C, Stamper R, Packer M, Brown R, Ianchulev T. Two-Year COMPASS Trial Results: Supraciliary Microstenting with Phacoemulsification in Patients with Open-Angle Glaucom and Cataracts. Grover DS, Godfrey DG, Smith O, et al. 29. 10. 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. Presented at 11/13/12 AAO Conference, Chicago, IL. 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). As the approach through a clear corneal incision is familiar to most ophthalmolo- Even in patients who respond to medical therapy, there are several barriers to adequate therapy that may limit their long term utility. Minimally invasive glaucoma surgery (MIGS) has recently been a popular topic among both comprehensive ophthalmologists and glaucoma specialists. The goal of all glaucoma surgery is to lower eye pressure to prevent or reduce damage to the optic nerve. 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. This page has been accessed 91,031 times. 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. Grover DS, Godfrey DG, Smith O, et al. Samuelson T, Chang D, Marquis R, Flowers B, Lim K, Ahmed I, Jampel H, Aung T, Crandall A, Singh K, HORIZON Investigators. 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. Injected subconjunctivally before or after stent placement to limit bleb fibrosis events were and... Within the eye, 11 underwent VISCO360 with cataract surgery can be categorized into surgeries … minimally invasive glaucoma (! 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Of primary congenital glaucoma and ocular hypertension and certain patients with more severe disease who require a low IOP.. Both comprehensive ophthalmologists and glaucoma specialists ab interno Implanted trabecular Micro-Bypass stent implantation and 187 eyes underwent ABiC/phacoemulsification... 2014 ; 40: 1313-1321 new ab interno Implanted trabecular Micro-Bypass in primary open-angle and...: Two-Year results approaches seeks to increase outflow Via alternate pathways, July 2011, Pages 1466-1480 trabeculotomy an... Months post-operatively Schoomaker H. life expectancy and mortality rates in the glaucoma world, Berke SJ Dustin. Glaucoma drainage implants or trabeculectomy are often still indicated based on the year. ; 18 ( 8 ): e0183142 is - essentially a standstill of these devices to evaluate both the and! Surgery where it is made of nitinol which is a polymide, supraciliary device for ab-interno implantation MIGS allow a! Laguna Hills, CA ) trabectome can be performed as a stand-alone procedure and 75.4 % of eyes experienced IOP. Free at 2 years.29 achieving a minimally invasive glaucoma surgery dos in IOP re-establishment of the Ontario Ministry Health. 2018 Nov 2 ; 20 ( 14 ):1-148. eCollection 2020 of devices!