The question of whether to perform phacoemulsification before or after TM-based MIGS is a matter of surgeon preference, says Kateki Vinod, MD.
Reviewed by Kateki Vinod, MD
Trabecular meshwork (TM)-based microinvasive glaucoma surgeries (MIGS) include both implanted stents as well as procedures for TM unroofing and ablation. Though generally among the safest glaucoma procedures, they are not without risk, said Kateki Vinod, MD. Complications associated with TM-based MIGS tend to be infrequent, self-limited, and non-vision threatening.
Nonetheless, surgeons can take steps preoperatively and during surgery to minimize risk, said Dr. Vinod, assistant professor, New York Eye and Ear Infirmary of Mount Sinai, New York.
Two main strategies for avoiding complications are selecting an appropriate patient and optimizing the intraoperative view, Dr. Vinod said. The ideal patient for TM-based MIGS has a clear cornea with no significant ocular surface disease, corneal opacities, or endothelial dysfunction.
A wide-open angle with well-delineated structures is also essential, as is the absence of prior angle-based surgery. Patients under consideration for TM-based MIGS should not have systemic morbidities that may compromise surgical success—for example, the inability to rotate the head and neck during surgery. One common concern related to patient selection is whether it is safe to perform TM-based MIGS in patients who are receiving anticoagulation or anti-platelet therapy for cardiac disease or stroke prevention.
Kateki Vinod, MD
E: [email protected]
This article was adapted from Dr. Vinod’s presentation at the 2019 meeting of the American Glaucoma Society. Dr. Vinod did not report any financial disclosures