Minimally Invasive Glaucoma Surgery (MIGS)

iStent Inject for Glaucoma

The iStent Inject is the most current and advanced device for glaucoma therapy that is implanted during cataract surgery. The iStent Inject is designed to reduce eye pressure and possibly the need for eye drops. Unlike its predecessor, the iStent, the iStent Inject creates two bypasses, or openings, between the front part of the eye and the natural drainage pathway to help restore your eye’s natural ability to drain fluid. Unlike eye drops, the device is designed to work continuously. It has been proven to effectively manage the pressure and prevent the progression of glaucoma. In clinical trials, most patients maintained healthy eye pressure years after their procedure.

The stent is placed during cataract surgery in an outpatient facility under local and intravenous sedation. Surgery is quick, painless and post-operative care and recovery are minimal. Patients will continue their glaucoma drops after surgery and be closely monitored by their surgeon to determine when and how to reduce their glaucoma drops once pressures are stable.

The surgeon will examine a patient’s eyes to determine if they are healthy before considering whether or not the patient is a good candidate. iStents are a viable option for any glaucoma patient but are not currently approved for children or other individuals suffering from angle closure glaucoma.

iStents are very small tubes, approximately 1-millimeter-long, that are inserted into the eye. After applying a topical anesthetic to numb the eye, your ophthalmologist will try to restore the natural pathway of aqueous outflow by placing the micro-stent into the Schlemm’s canal in order to bypass the trabecular meshwork, the main source of aqueous outflow resistance. The stent then acts as a drainage system between the anterior chamber of the eye and Schlemm’s canal and permits the eye to drain fluid, thus reducing intraocular pressure. The iStent is the smallest implant to be placed in the human body and has proven clinical results to help lower intraocular pressure in patients with mild to moderate glaucoma. The iStent is only done in conjunction with cataract surgery. 

The Kahook Dual Blade is one of the latest treatments for patients with glaucoma. It is a surgical procedure that uses a high-tech, single-use ophthalmic blade to safely remove part of the trabecular meshwork and create an opening into the Schlemm’s canal in order to relieve intraocular pressure. Through one incision, up to 180 degrees of the trabecular meshwork can be removed.

The goal of treatment is to increase aqueous outflow by allowing it to flow unimpeded by “diseased” trabecular meshwork which is a compelling factor in glaucoma control.

The surgery offers the advantage of being an outpatient procedure done under local anesthesia with intravenous sedation. It is quick and painless with a rapid recovery time since sutures are not required. Also, unlike traditional trabeculectomies, there are is no risk of a bleb-related complication like leak or infection.

The postoperative care of this procedure when done alone is with an NSAID and topical antibiotic. The procedure has the flexibility of being done alone or alongside cataract surgery. When done in conjunction with cataract surgery, it is often done through the same incision following cataract removal with a similar post-operative medication schedule.

ABiC Treatment for Glaucoma

ABiC, or Ab Interno Canaloplasty, is a canal-based glaucoma surgery. The mechanism of action includes restoring the natural outflow pathway with minimal tissue trauma. The physician is trained to use a microcatheter to vasodilate the trabecular meshwork, Schlemm’s canal, and collector channels within the eye 360º around at every 2-hour mark. There is no tissue damage, stents, shunts or implants involved with the procedure and it can be performed on its own or in conjunction with cataract surgery. 

The postoperative care of this procedure when done alone is with an NSAID and topical antibiotic eye drop. When done in conjunction with cataract surgery, it is often done through the same incision following cataract removal with a similar post-operative medication schedule. The surgery is done as an outpatient procedure under local anesthesia with intravenous sedation. It is quick and painless with a rapid recovery time since sutures are not required.