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What is Minimally Invasive Glaucoma Surgery (MIGS)?

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At Blue Fin Vision®, our premier eye clinic on Harley Street in London, we’re committed to offering the most advanced treatments for glaucoma. One of the most exciting developments in recent years is Minimally Invasive Glaucoma Surgery, or MIGS. This innovative approach to glaucoma treatment has revolutionised the way we manage this sight-threatening condition. In this comprehensive guide, we’ll explore what MIGS is, how it works, and why it might be the right choice for many glaucoma patients.

Understanding MIGS

Minimally Invasive Glaucoma Surgery refers to a group of surgical procedures designed to lower intraocular pressure (IOP) in patients with glaucoma. These procedures are characterised by their minimal tissue disruption, high safety profile, and rapid recovery time.

Key Features of MIGS

  1. Minimally invasive approach: As the name suggests, MIGS procedures involve very small incisions and minimal tissue disruption.
  2. Ab interno approach: Most MIGS procedures are performed from inside the eye, reducing the need for extensive external incisions.
  3. Conjunctival sparing: Unlike traditional glaucoma surgeries, MIGS preserves the conjunctiva, which is crucial for potential future treatments.
  4. Rapid recovery: Patients typically experience faster recovery times compared to traditional glaucoma surgeries.
  5. High safety profile: MIGS procedures generally have fewer complications than more invasive glaucoma surgeries.
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Types of MIGS Procedures

There are several types of MIGS procedures, each targeting different aspects of the eye’s drainage system. At our London eye clinic, we offer a range of MIGS options to suit individual patient needs:

  1. Trabecular Meshwork Bypass Stents

These tiny devices are implanted to create a bypass through the trabecular meshwork, allowing aqueous humour to flow more freely into Schlemm’s canal. Examples include:

  • iStent
  • iStent inject
  • Hydrus Microstent
  1. Subconjunctival Drainage Devices

These implants create an alternative pathway for aqueous humor to exit the eye. The XEN Gel Stent is a prime example of this type of MIGS device.

  1. Suprachoroidal Shunts

These devices facilitate drainage into the suprachoroidal space. While not currently available in the UK, they represent an exciting area of ongoing research.

  1. Trabecular Meshwork Ablation

These procedures remove a portion of the trabecular meshwork to improve outflow. Examples include:

  • Trabectome
  • Kahook Dual Blade goniotomy
  • Gonioscopy-assisted transluminal trabeculotomy (GATT)

Benefits of MIGS

Minimally Invasive Glaucoma Surgery offers several advantages over traditional glaucoma surgeries:

  1. Reduced surgical trauma: The minimally invasive nature of MIGS results in less tissue damage and inflammation.
  2. Faster recovery: Most patients can return to normal activities within days of the procedure.
  3. Lower risk of complications: MIGS procedures have a better safety profile compared to traditional glaucoma surgeries.
  4. Preserves anatomical structures: By sparing the conjunctiva, MIGS procedures don’t “burn bridges” for future treatments.
  5. Can be combined with cataract surgery: Many MIGS procedures can be performed at the same time as cataract surgery, addressing both issues simultaneously.
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Who is a Candidate for MIGS?

While MIGS can be beneficial for many glaucoma patients, it’s particularly well-suited for:

  • Patients with mild to moderate glaucoma
  • Those who are intolerant to glaucoma medications
  • Patients undergoing cataract surgery who also have glaucoma
  • Individuals who have not achieved adequate IOP control with medications or laser treatments

At Blue Fin Vision®, our experienced ophthalmologists carefully assess each patient to determine the most appropriate treatment option.

The MIGS Procedure

While the specific steps vary depending on the type of MIGS procedure, most share some common elements:

  1. Anaesthesia: Most MIGS procedures are performed under local anaesthesia.
  2. Small incision: A tiny incision is made in the cornea.
  3. Device implantation or tissue manipulation: Depending on the specific procedure, a device may be implanted, or tissue may be altered to improve drainage.
  4. Closure: In many cases, the small incision is self-sealing and doesn’t require sutures.

The entire procedure typically takes 10-30 minutes, often less if combined with cataract surgery.

Recovery and Aftercare

One of the significant advantages of MIGS is the rapid recovery time. Most patients can return to normal activities within a few days. However, it’s essential to follow your surgeon’s post-operative instructions carefully:

  • Use prescribed eye drops as directed
  • Avoid strenuous activities for a short period
  • Wear an eye shield while sleeping for the first few nights
  • Attend all follow-up appointments

Potential Risks and Complications

While MIGS procedures are generally very safe, as with any surgery, there are some potential risks:

  • Temporary increase in IOP
  • Mild inflammation
  • Bleeding in the eye
  • Infection (very rare)
  • Device malposition or obstruction (for stent procedures)

At Blue Fin Vision®, we thoroughly discuss all potential risks and benefits with our patients before proceeding with any treatment.

The Future of MIGS

The field of Minimally Invasive Glaucoma Surgery is rapidly evolving. Ongoing research is focused on developing new devices and refining existing techniques. Some exciting areas of development include:

  • Combination therapies using multiple MIGS devices
  • Drug-eluting stents that deliver medication directly to the target tissues
  • Improved imaging technologies to guide MIGS procedures

As a leading eye clinic in London, Blue Fin Vision® is committed to staying at the forefront of these developments, ensuring our patients have access to the most advanced treatments available.

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Why Choose Blue Fin Vision® for MIGS?

At Blue Fin Vision®, our Harley Street clinic offers:

  1. Expert surgeons: Our team of ophthalmologists are highly experienced in performing MIGS procedures.
  2. State-of-the-art technology: We use the latest equipment to ensure optimal outcomes for our patients.
  3. Personalised care: We tailor our treatment plans to each patient’s unique needs and circumstances.
  4. Comprehensive approach: We offer a full range of glaucoma treatments, allowing us to provide the most appropriate care for each individual.
  5. Convenient location: Our central London location makes us easily accessible for patients throughout the city and beyond.

Conclusion: A New Era in Glaucoma Treatment

Minimally Invasive Glaucoma Surgery represents a significant advancement in the treatment of glaucoma. By offering effective IOP reduction with a high safety profile and rapid recovery, MIGS has filled an important gap in the glaucoma treatment paradigm.

At Blue Fin Vision®, we’re excited to offer these innovative procedures to our patients. If you’ve been diagnosed with glaucoma or are concerned about your eye pressure, we encourage you to book a consultation at our London eye clinic. Our expert team can assess your individual case and determine whether MIGS might be an appropriate treatment option for you.

Remember, early detection and treatment are crucial in managing glaucoma and preserving your vision. Don’t wait to take control of your eye health. Contact Blue Fin Vision® today to schedule your comprehensive eye examination and explore the potential benefits of MIGS.

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