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Choice of MIGS depends on variable patient factors
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CHICAGO — A glaucoma surgeon should be able to perform at least two or more procedures with different methods of action in the MIGS category and should have at least one procedure that can be done in a phakic or pseudophakic patient that is not limited to cataract extraction, according to a speaker here.
When choosing a minimally invasive glaucoma surgery (MIGS) procedure, surgeons should take several patient factors into account, Brian A. Francis, MD, said at the Glaucoma Subspecialty Day preceding the American Academy of Ophthalmology meeting.
“The questions you want to ask yourself are, is there a coexisting cataract? What is the diagnosis? What is the anatomy of the eye? What is the target IOP? What medications can the patient use? And what is the patient’s preference or lifestyle that might affect this?”
Currently, MIGS devices are only approved with cataract surgery. To reduce the medication burden, MIGS is a consideration in cataract patients whose disease is controlled but who is on multiple medications.
“Angle closure glaucoma may improve with cataract extraction alone but may require a MIGS procedure with it. [Endoscopic cyclophotocoagulation) is difficult in a phakic eye, so it has to be done with cataract surgery or in an eye that is pseudophakic,” Francis said.
All MIGS procedures are appropriate for patients with primary open-angle glaucoma. For exfoliation glaucoma, a MIGS procedure that targets trabecular outflow is appropriate. MIGS and goniosynechialysis, aqueous inflow procedures or subconjunctival procedures are appropriate to address chronic angle closure glaucoma, Francis said.
“Trabecular outflow procedures for me are usually first line, but aqueous inflow procedures are very versatile, and you should think about combining procedures as well,” Francis said. – by Robert Linnehan
Reference: Francis BA. How do I choose the right MIGS? Presented at: AAO Subspecialty Day; Oct. 26-27, 2018; Chicago.
Disclosure: Francis reports no relevant financial disclosures.