Understanding Minimally Invasive Glaucoma Surgery
Minimally invasive glaucoma surgery has blossomed to include multiple options for different patient types. “The problem…is that we are victims of paralysis by analysis,” observed Michael Patterson, DO, an ophthalmologist at Eye Centers of Tennessee in Crossville, TN, in a recent article. He attempted to lend clarity by offering these MIGS pearls:
- Mange risk. For patients with mild glaucoma, use simple, low-risk devices. Stay away from choroidal folds and permanent maculopathy.
- Cataract surgery first. When starting out in phakic patients, perform cataract surgery initially. This way, if you struggle and need to abort, the cataract surgery is still performed.
- MIGS early in psudophakic patients. These patients need and can benefit from MIGS the most. Low-risk surgical options are now available. This is especially true for patients whose condition is getting worse despite use of drops.
- Head tilt is important. More head tilt it better. Don’t use MIGS in those who are not able to turn their head. “The angle must be visualized well when starting out.”
- Blood thinners? This is controversial, but it is probably not a good idea to stop blood thinners because it introduces the chance of a stroke. The only exception is when doing 360-degree angle.
- Anesthesia preference. Use IV sedation initially, which helps with discomfort and decreases stress.
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Patterson M. The wonderful world of MIGS. [Published online February 1, 2019. Ophthalmology Management. https://www.ophthalmologymanagement.com/issues/2019/february-2019/the-wonderful-world-of-migs