Minimally Invasive Glaucoma Surgery

Overview of micro-invasive glaucoma surgery.- Anatomy of aqueous outflow drainage pathways.- MIGS: iStent Trabecular Microbypass Stent and iStent Inject.- MIGS: Ab Interno Trabeculotomy (Trabectome).- MIGS: Hydrus.- MIGS: XEN Implant.- MIGS: Microshunt.- MIGS: Cypass and iStent Supra.- MIGS: new modalities of cycloablation and high-intensity focused ultrasound.- Controversies in the use of MIGS.- Globalization of MIGS.

The book is provided open access under a CC BY 4.0 license. This book covers all aspects of micro-invasive glaucoma surgery (MIGS) and provides detailed information on each MIGS device, including its mechanism of action; patient selection; implantation techniques; post-operative management; and a review of the existing literature. Step-by-step descriptions are provided for the surgical technique used in implanting each MIGS device, accompanied by clear photographs of each surgical stage. Flow charts have been included to illustrate differences in patient selection between the respective devices, together with essential information on the anatomy and physiology of the different aqueous outflow pathways they use.

Further topics include intra-operative gonioscopy (with tips on optimising the view of the anterior chamber angle) and the management of intra-operative and post-operative complications. A separate section addresses the introduction of MIGS globally, including the consideration of different reimbursement environments and different types of glaucoma, e.g. angle closure glaucoma. Given its scope, the book assists both glaucoma surgeons and general ophthalmologists in overcoming the learning curve involved in performing MIGS, by providing valuable clinical and practical information.

Dr Chelvin Sng (MBBChir, MA, FRCSEd) graduated from Cambridge University, UK, with triple first class honours and distinctions. She is amongst the first surgeons in Asia to be accredited in the use of several micro-invasive glaucoma surgery (MIGS) devices, including the iStent trabecular microbypass stent, the iStent Inject, the XEN-45 gel stent and the trabectome. She has been awarded $800,000 in research funding to investigate the outcomes of MIGS in Asian patients. Dr Sng was the most outstanding candidate in her year for the ophthalmology specialist accreditation examination (Singapore), with gold medals conferred for being the best candidate in glaucoma, cataract and refractive surgery, neuro-ophthalmology and paediatric ophthalmology. She has more than 50 peer-reviewed international publications to her credit, and has received international awards and grants from the American Academy of Ophthalmology, the Australian and New Zealand Glaucoma Interest Group, the Association for Research in Vision and Ophthalmology, and the American Society of Cataract and Refractive Surgeons. She has also been awarded the Singapore Society of Ophthalmology Young Ophthalmologist Award and a New Investigators Grant from the National Medical Research Council (Singapore). Dr Sng is the co-inventor of a novel patented glaucoma drainage device that is currently undergoing commercialization, and is a co-author of the book The Ophthalmology Examinations Review, which is frequently used by ophthalmology residents who are preparing for postgraduate examinations.

Dr Keith Barton (BSc, MBBCh BAO, FRCS, FRCP) is a consultant ophthalmologist at the glaucoma service, Moorfields Eye Hospital and the editor-in-chief of the British Journal of Ophthalmology. He is on the advisory board for several MIGS devices, including the Allergan XEN-45 implant, the Santen Microshunt, and the Alcon Cypass. Dr Barton is the chairman of the International Glaucoma Association, the Hong Leong Visiting Professor at the National University of Singapore, and a member of the glaucoma guidelines implementation group of the National Institute for Health and Clinical Excellence. Dr Barton has received the National Silver Clinical Excellence Award from the National Health Service Advisory Committee, and the Gold Medal of Merit and Honour from the Greek Glaucoma Society