Minimally Invasive Eye Surgery (MIGS) is a category of procedures used to treat glaucoma, aimed at reducing intraocular pressure (IOP) with less risk, fewer complications, and a faster recovery time compared to traditional glaucoma surgeries. Here's a detailed look at MIGS:


Types of Minimally Invasive Glaucoma Surgery:

  1. Trabecular Bypass Procedures:

    • iStent: A tiny titanium stent implanted to bypass the trabecular meshwork, enhancing the natural outflow of aqueous humor. It's often performed alongside cataract surgery.

    • Hydrus Microstent: Similar to iStent but spans a larger area of Schlemm's canal to facilitate better fluid drainage.

    • Kahook Dual Blade (KDB): Used for goniotomy, creating small incisions in the trabecular meshwork to improve drainage.

  2. Suprachoroidal or Subconjunctival Shunts:

    • XEN Gel Stent: A gel implant that creates a pathway for fluid to flow from the anterior chamber to the subconjunctival space, reducing IOP.

    • PRESERFLO: Another micro-shunt designed for drainage to the subconjunctival space.

  3. Laser-Based MIGS:

    • Endocyclophotocoagulation (ECP): Uses laser to reduce the fluid production by targeting the ciliary body.

    • Micropulse Cyclophotocoagulation: A less invasive form of cyclophotocoagulation, aiming to lower IOP by reducing aqueous humor production with less risk of damage to the surrounding tissue.

  4. Canaloplasty and Ab Interno Canaloplasty (ABiC):

    • These procedures dilate Schlemm's canal to enhance outflow, either from the inside (ab interno) or outside (ab externo) of the eye.

  5. Gonioscopy-Assisted Transluminal Trabeculotomy (GATT): A method where a catheter or suture is used to create a 360-degree opening in the trabecular meshwork for better fluid drainage.


Indications for MIGS:

  • Mild to Moderate Glaucoma: MIGS is particularly suitable for patients with mild to moderate open-angle glaucoma where conventional treatments like eye drops or laser therapy have not been sufficient or are not well-tolerated.

  • Patients with Cataracts: MIGS can be combined with cataract surgery, offering a dual benefit of managing glaucoma and improving vision. This approach can reduce the dependency on glaucoma medications post-surgery.

  • Non-Compliance or Intolerance to Medications: For patients who cannot adhere to a regimen of eye drops or experience side effects, MIGS provides a more permanent solution with fewer side effects.

  • High-Risk Groups: Patients at higher risk for complications from traditional surgery, such as those with thin conjunctiva or previous surgeries, might benefit from MIGS due to its less invasive nature.


MIGS is designed to improve quality of life by reducing the need for daily medication, minimizing postoperative complications, and offering a quicker recovery, making it a promising option in modern glaucoma management. However, it's important to note that MIGS might not be as effective in achieving very low IOP as some traditional surgeries for more severe cases, and the choice of procedure should be tailored to the individual patient's needs, eye health, and overall medical condition.