Question

Enumerate types of MIGS devices available.

Hint:

The choice of MIGS device depends on the patient’s specific glaucoma type, the severity of the disease, and the desired surgical outcome.

Answer 1

There are several MIGS devices designed to enhance aqueous humor drainage and lower intraocular pressure (IOP) with minimal invasiveness. These devices primarily target different parts of the trabecular meshwork, schlemm’s canal, and drainage pathways in the eye. The types of MIGS devices available include:
1. iStent (Glaukos):
- The iStent is a small, titanium device that is implanted into the trabecular meshwork to improve aqueous humor drainage through Schlemm's canal. It is typically implanted during cataract surgery.
2. iStent Inject (Glaukos):
- A more advanced version of the iStent, the iStent Inject involves the implantation of two stents into the trabecular meshwork, improving drainage and IOP control.
3. Hydrus Microstent (Ivantis):
- The Hydrus Microstent is a small, flexible device that is placed into the trabecular meshwork and Schlemm’s canal, providing a scaffold to allow for improved aqueous outflow.
4. Xen Gel Stent (AbbVie):
- The Xen Gel Stent is a non-absorbable, gelatin stent that creates a drainage pathway from the anterior chamber to the subconjunctival space, bypassing the trabecular meshwork and Schlemm’s canal.
5. Kahook Dual Blade (New World Medical):
- The Kahook Dual Blade is a device used to perform goniotomy, where a portion of the trabecular meshwork is removed to increase aqueous outflow. It is used in combination with other MIGS techniques.
6. Trabectome (NeoMedix):
- The Trabectome is a minimally invasive surgical device that removes part of the trabecular meshwork to improve fluid drainage through the trabecular outflow pathway.
7. Omni Surgical System (Sight Sciences):
- The Omni Surgical System is a device that can perform both goniotomy and trabeculotomy via a single micro-incision, addressing both the trabecular meshwork and Schlemm’s canal to enhance drainage.
8. CyPass Micro-Stent (Alcon):
- The CyPass Micro-Stent was designed to provide drainage by creating an outflow pathway from the anterior chamber to the suprachoroidal space. However, its use has been discontinued due to concerns about long-term endothelial cell loss.