MIGS

Redefining Glaucoma Surgery with MIGS

Advances in the development of Micro-Invasive Glaucoma Surgery (MIGS) have brought new excitement to glaucoma treatment. Most commonly used in patients with mild-to-moderate open-angle glaucoma undergoing cataract surgery, MIGS refers to a group of surgical procedures that share the following features.

  • Minimal trauma
  • Efficacy
  • High safety profile
  • Rapid recovery

MIGS is recognized as a micro-invasive treatment option that can reestablish the eye’s physiological outflow, in order to reduce intraocular pressure (IOP).1

Many physicians agree that restoring physiological outflow is preferable in the majority of patients. Compared to more invasive glaucoma surgeries with high complications and risks prolonged with postoperative recovery, MIGS procedures have minimal morbidity, fast recovery, and few complications.2*

As the corporate founder of MIGS, Glaukos revolutionized the traditional glaucoma treatment and management paradigm with the iStent® Trabecular Micro-Bypass Stent—the first MIGS device approved by the FDA. And with the FDA approval of iStent inject® and now iStent inject® W – the next-generation Glaukos trabecular micro-bypass technology – Glaukos continues to advance the standard of care for glaucoma patients.

Many physicians agree that restoring physiological outflow is preferable in the majority of patients. Compared to more invasive glaucoma surgeries with high complications and risks prolonged with postoperative recovery, MIGS procedures have minimal morbidity, fast recovery, and few complications.2*

As the corporate founder of MIGS, Glaukos revolutionized the traditional glaucoma treatment and management paradigm with the iStent® Trabecular Micro-Bypass Stent—the first MIGS device approved by the FDA. And with the FDA approval of iStent inject® and now iStent inject® W – the next-generation Glaukos trabecular micro-bypass technology – Glaukos continues to advance the standard of care for glaucoma patients.

*Indications for MIGS are different compared to invasive glaucoma surgeries and do not include patients with advanced disease or patients who require very low unmedicated postoperative IOP.

  1. Saheb H. Ahmed II. Micro-invasive glaucoma surgery; current perspectives and future directions. Curr Opin Ophthalmol. 2012; 23(2):96-104.
  2. Gedde SJ, Herndon LW, Brandt JD, et al. Postoperative Complications in the Tube Versus Trabeculectomy (TVT) Study During Five Years of Follow-up. Am J Ophthalmol. 2012;153(5):804-814.e1. doi:10.1016/j.ajo.2011.10.024.

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Glaucoma Therapies

iStent inject® W

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The words iStent Inject® alongside the actual iStent Inject W device.
The words iStent Inject® alongside the actual iStent Inject W device.

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iStent inject® W Important Safety Information

Indication for Use

The iStent inject® W Trabecular Micro-Bypass System Model G2-W is indicated for use in conjunction with cataract surgery for the reduction of intraocular pressure (IOP) in adult patients with mild to moderate primary open-angle glaucoma.

Contraindications

The iStent inject® W is contraindicated in eyes with angle-closure glaucoma, traumatic, malignant, uveitic, or neovascular glaucoma, discernible congenital anomalies of the anterior chamber (AC) angle, retrobulbar tumor, thyroid eye disease, or Sturge-Weber Syndrome or any other type of condition that may cause elevated episcleral venous pressure.

Warnings

Gonioscopy should be performed prior to surgery to exclude congenital anomalies of the angle, PAS, rubeosis, or conditions that would prohibit adequate visualization of the angle that could lead to improper placement of the stent and pose a hazard.

MRI Information

The iStent inject® W is MR-Conditional, i.e., the device is safe for use in a specified MR environment under specified conditions; please see Directions for Use (DFU) label for details.

Precautions

The surgeon should monitor the patient postoperatively for proper maintenance of IOP. The safety and effectiveness of the iStent inject® W have not been established as an alternative to the primary treatment of glaucoma with medications, in children, in eyes with significant prior trauma, abnormal anterior segment, chronic inflammation, prior glaucoma surgery (except SLT performed > 90 days preoperative), glaucoma associated with vascular disorders, pseudoexfoliative, pigmentary or other secondary open-angle glaucomas, pseudophakic eyes, phakic eyes without concomitant cataract surgery or with complicated cataract surgery, eyes with medicated IOP > 24 mmHg or unmedicated IOP < 21 mmHg or > 36 mmHg, or for implantation of more or less than two stents.

Adverse Events

Common postoperative adverse events reported in the iStent inject® randomized pivotal trial included stent obstruction (6.2%), intraocular inflammation (5.7% for iStent inject® vs. 4.2% for cataract surgery only), secondary surgical intervention (5.4% vs. 5.0%) and BCVA loss ≥ 2 lines ≥ 3 months (2.6% vs. 4.2%).

Caution

Federal law restricts this device to sale by, or on the order of, a physician. Please see DFU for a complete list of contraindications, warnings, precautions, and adverse events.

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