Minimally Invasive Glaucoma Surgeries (MIGS)

Minimally Invasive Glaucoma Surgeries (MIGS) are a group of procedures used when eye pressure is not adequately controlled with medications or laser alone, typically in patients with mild to moderate open-angle glaucoma. The goal of MIGS is to lower intraocular pressure and reduce dependence on eye drops while maintaining a high safety profile. These procedures are often performed at the same time as cataract surgery but can also be done on their own in select cases.

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iStents are tiny implanted devices placed into the eye’s natural drainage pathway (the trabecular meshwork) to improve fluid outflow. By creating a direct channel into Schlemm’s canal, iStents help aqueous humor drain more efficiently, leading to modest but meaningful pressure reduction with minimal disruption to eye anatomy. They are commonly used in patients undergoing cataract surgery who need additional pressure control with low risk.

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Goniotomy involves removing or opening a strip of the trabecular meshwork to allow better access to the eye’s drainage system. This can be done using specialized instruments under direct visualization and improves outflow through the natural canal system. Canaloplasty with the OMNI device combines goniotomy with viscodilation of Schlemm’s canal and the distal outflow channels. The OMNI device is used to catheterize and gently dilate the canal, addressing multiple points of resistance to outflow. Together, these MIGS options provide flexible, tissue-sparing ways to lower eye pressure while preserving future surgical options if more aggressive treatment is ever needed.