Benefits of adding MIGS to phaco

Roibeard O’hEineachain

Posted: Tuesday, December 15, 2020

Julian Garcia-Feijoo MD

Adding microinvasive glaucoma surgery (MIGS) to phacoemulsification enhances the moderate IOP lowering effect of the cataract procedure and reduces the need for postoperative medication in the medium term in glaucoma patients, according to Prof Julian Garcia-Feijoo MD, H.Clinico San Carlos. Universidad Complutense, Madrid, Spain. “MIGS has become widely available, but it plays a different role than more invasive surgeries within the glaucoma treatment algorithm, Prof Feijoo told the 14th European Glaucoma Society Congress. He noted that, whereas the goal of trabeculectomy and other forms of fistularising surgeries is to reduce IOP to 12 mmHg or below in eyes with advanced glaucoma , the goal of MIGS is to reduce IOP to the 15-20mmHg in patients with milder glaucoma and reduce, if not eliminate, the need for pressure lowering eyedrops.
When patients undergo MIGS combined with cataract surgery their IOP is typically in the mid-teens postoperatively and they have a better than 80% chance of not needing medications for two years if they were receiving two-to-three medications preoperatively, he pointed out. Cataract surgery alone achieves a similar but slightly lower IOP reduction, but leaves patients at a higher risk of needing eye drops postoperatively. Furthermore, the IOP reduction following cataract surgery alone is much more variable.
Dr Feijoo added that combined MIGS and cataract procedures are generally as safe as cataract surgery alone. Furthermore, a cataract in a glaucoma patient represents a window of opportunity to surgically intervene with minimal additional trauma. Moreover, the reduced need for topical medications preserves the health of the conjunctiva, making patients better candidates for trabeculectomy should it later become necessary.