MIGS glaucoma surgery is minimally invasive glaucoma surgery, done basically through a
small micro-incision to simplify surgery to allow the surgery to be done through a keyhole.
So, we are now doing procedures instead of having to make big cuts and stitches and,
you know, the longer recovery, the procedure's simplified and we have a quicker recovery.
The procedure is done as a day case, the patient will come in for the surgery and go home the
same day, a few-- an hour or so after the procedure and the eye recovers a lot quicker
than the traditional methods we have, because the wound is so small and the incision, you
know, will self-heal in many cases.
MIGS has allowed us to do safer surgery just as effective as our standard procedures such
as the trabeculectomy, and in many cases it's simplified the procedure and allowed patients
safer and a quicker recovery.
Minimally invasive surgeries are expanding every month or certainly every year there
are new procedures coming out. They all centre on two things. One: doing the procedure through
a micro-incision, so it's all just a very small one millimetre incision or even less,
and secondly: increasing the drainage either through the traditional method of through
the conjunctiva where we're making a new outlet for the fluid to flow out and a lot of times
we put in little micro implants such as a mini little tube or a gel stent, and a lot
of the MIGS surgery is involved, surgeries in the drainage angle which is the actual
natural pathway which is 360 degrees around where your iris meets your cornea, and you
can insert little stents to open up that natural pathway and many times that will allow the
pressure to come down and a lot of times people do not need any further eyedrops for example.
So, MIGS has allowed us all of the surgeries involved increasing the drainage out of the
eye. Some of them like I said the making a new outlet which, I, in a lot of cases in
advanced glaucoma is more effective than putting the stents sometimes in the natural pathways,
which the natural pathways, you know, as the glaucoma progresses sometimes doesn't allow
for as effective drainage as if we went and made a new outlet. But because these implants
are all microscopic and smaller than the traditional ones, the surgery is a lot quicker and safer.
You don't need to be put to sleep to have MIG surgery. In fact, most patients, you know,
are done under just topical drops with some anaesthetic solution going into the eye during
the procedure which keeps the patient completely comfortable. You know, any eye surgery involves
being very still to allow the procedure to be performed in a safe manner. So, it's up
to your surgeon to make sure you're completely comfortable and there's no pain involved.
So very, very rarely do we put patients to sleep and it's usually because the patient
is nervous and would prefer it, but it's certainly not required for any MIG surgery.
A standard trabeculectomy is our gold standard procedure for lowering the eye pressure. Lowering
the eye pressure is done to lower the risk of any further glaucoma damage to your eye
and your vision. So trabeculectomy, what that does is makes a hole into the wall of the
eye which is then covered up and stitched up so that your drainage of your fluid goes
from inside your eyeball into the skin of the eyeball: the white of the eye called the
conjunctiva. So that's our gold standard procedure and what MIG surgery does is try to mimic
that either in the same way by making an outlet. So some of the little mini tubes that we have
or the gel stent we have will try to make a new channel just like a trabeculectomy does,
but without the stitches, without the big cuts, quicker recovery, a safer procedure
with less complications, and in many cases just as effective as a trabeculectomy. So,
a lot of the MIG surgeries will focus on trying to mimic a trabeculectomy in the hope of making
it as effective as a trabeculectomy, but like I said, safer and a lot quicker procedure
and a quicker recovery for our patients. Some of the other MIGS procedures, the microscopic
implants that we put in the drainage angles, try to avoid making a new channel in the hope
of working better with what we already have at the actual drainage channel within the
eye, if we can put a stent in or scaffolding in to open the natural channel, then that
is effective in some patients. Now, in my own experience as the disease progresses,
then sometimes you do need to do something else than just putting a tube or a mini implant
into the actual natural channel. It's sometimes better to make a new channel and you get much
lower pressure.