Which MIGS device to use in a patient with glaucoma?

[caption id="attachment_7632" align="alignnone" width="750"] Keith Barton[/caption] The choice of which minimally invasive glaucoma surgery (MIGS) device to implant depends on whether the aim is to reduce the need for medication or to gain better control of the disease, says Keith Barton MD, FRCP, FRSCS, Moorfields Eye Hospital, London, UK. Speaking at the 21st ESCRS Winter Meeting in Maastricht, The Netherlands, he noted that devices which direct aqueous outflow through Schlemm’s canal, like the first-generation iStent, are most appropriate for eyes with mild glaucoma that is reasonably well-controlled with medication. Dr Barton pointed out that, in the Ocular Hypertension Treatment Study (OHTS), cataract surgery alone reduces intraocular pressure (IOP) by 16.5% on average, or roughly half the IOP reduction provided by topical latanoprost. Moreover, around 40% of eyes achieved 20% reduction. However, these results were achieved without reductions in medication usage.

In eyes where glaucoma is progressing despite maximal medication, trabeculectomy remains the best option

In the early trials with first-generation iStents, 66% of eyes with the drainage implants compared achieved 20% IOP reduction, but also had a reduction in their requirement for IOP-lowering medications. In trials with ab interno MIGS devices which direct aqueous out to the subconjunctival space, like the XEN implant, the implants have achieved 30% to 40% IOP reductions in a high proportion of patients. The jury is still out regarding implants that direct aqueous to the suprachoroidal space. In general, MIGS devices should be restricted to patients with mild to moderate glaucoma controlled by medication. In eyes where glaucoma is progressing despite maximal medication, trabeculectomy remains the best option, he concluded.