Minimally Invasive Techniques in Glaucoma Management
Summary
Minimally invasive techniques in glaucoma management encompass a spectrum of microincisional procedures designed to lower intraocular pressure (IOP) with fewer complications than traditional filtration surgeries. Collectively termed minimally invasive glaucoma surgery (MIGS), these methods seek to enhance aqueous humour outflow via physiological pathways or create controlled subconjunctival drainage without full-thickness scleral penetration. Two principal approaches prevail: ab interno procedures, which access the trabecular meshwork or suprachoroidal space through the anterior chamber, and ab externo procedures, which modify outflow via external application to the sclera or suprachoroidal region. Devices such as trabecular micro-bypass stents, gelatin-based subconjunctival implants and suprachoroidal shunts aim to reduce dependence on medications, deliver rapid visual recovery and lower risk of hypotony or bleb-related complications. The global significance of these advances lies in expanding surgical options for patients with early to moderate glaucoma, particularly in conjunction with cataract surgery, and offering scalable solutions for healthcare systems seeking safer and more cost-effective long-term IOP control.
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Minimally Invasive Techniques in Glaucoma Management publication trend
The graph below shows the total number of articles in minimally invasive techniques in glaucoma management across all publications each year (not limited to Nature Index journals).
Technical terms
Minimally invasive glaucoma surgery (MIGS): a group of microincisional or non-penetrating procedures reducing intraocular pressure with improved safety compared to traditional trabeculectomy or tube shunts.
Ab interno approach: a surgical technique entering the eye via a corneal incision to target the trabecular meshwork, suprachoroidal space or collector channels from inside the anterior chamber.
Ab externo approach: an external method accessing scleral or suprachoroidal pathways without entering the anterior chamber, often via conjunctival dissection.
Trabecular micro-bypass stent (iStent): a heparin-coated titanium implant inserted into Schlemm’s canal to facilitate aqueous outflow and lower IOP.
Subconjunctival gelatin implant: a biodegradable, gel-forming device delivered via ab interno technique to create a controlled subconjunctival drainage route for aqueous humour.
XEN Gel Stent: a cross-linked gelatin microtubule that shunts aqueous from the anterior chamber to the subconjunctival space, forming a bleb with minimal tissue disruption.
References
- Minimally-invasive glaucoma surgeries (MIGS) for open angle glaucoma: A systematic review and meta-analysis. PLOS ONE (2017).
- Two-year results of a multicenter study of the ab interno gelatin implant in medically uncontrolled primary open-angle glaucoma. Graefe's Archive for Clinical and Experimental Ophthalmology (2019).
- Micro‐Bypass Implantation for Primary Open‐Angle Glaucoma Combined with Phacoemulsification: 4‐Year Follow‐Up. Journal of Ophthalmology (2015).
- Update on Minimally Invasive Glaucoma Surgery (MIGS) and New Implants. Journal of Ophthalmology (2013).
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