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Techniques and outcomes of minimally invasive trabecular ablation and bypass surgery
  1. Kevin Kaplowitz1,
  2. Joel S Schuman2,3,
  3. Nils A Loewen2
  1. 1Department of Ophthalmology, Stony Brook University School of Medicine, Stony Brook, New York, USA
  2. 2Department of Ophthalmology, UPMC Eye Center, Eye and Ear Institute, Ophthalmology and Visual Science Research Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
  3. 3Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr Nils A Loewen, Department of Ophthalmology, University Pittsburgh Medical Center, 203 Lothrop St, Suite 819, Pittsburgh, PA 15213, USA; loewen.nils{at}gmail.com

Abstract

Minimally invasive glaucoma surgeries (MIGS) can improve the conventional, pressure-dependent outflow by bypassing or ablating the trabecular meshwork (TM), or creating alternative drainage routes into the suprachoroidal or subconjunctival space. They have a highly favourable risk profile compared to penetrating surgeries, and lower intraocular pressure with variable efficacy that may depend on the extent of outflow segments accessed. Since they are highly standardised procedures that use clear corneal incisions, they can elegantly be combined with cataract and refractive procedures to improve vision in the same session. There is a growing need for surgeons to become proficient in MIGS to address the increasing prevalence of glaucoma and cataracts in a well-informed, aging population. Techniques of visualisation and instrumentation in an anatomically highly confined space with semitransparent tissues are fundamentally different from other anterior segment surgeries, and present even experienced surgeons with a substantial learning curve. Here, we provide practical tips, and review techniques and outcomes of TM bypass and ablation MIGS.

  • Glaucoma
  • Treatment Surgery
  • Treatment Lasers
  • Angle

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