{"id":1584,"date":"2025-07-11T01:32:38","date_gmt":"2025-07-11T01:32:38","guid":{"rendered":"https:\/\/enfoca.com.mx\/?p=1584"},"modified":"2025-07-11T01:32:40","modified_gmt":"2025-07-11T01:32:40","slug":"cirugias-glaucoma-minima-invasiva-migs-mibs","status":"publish","type":"post","link":"https:\/\/enfoca.com.mx\/eng\/cirugias-glaucoma-minima-invasiva-migs-mibs\/","title":{"rendered":"MIGS \/ MIBS SHOWDOWN!"},"content":{"rendered":"<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"SAMUR A-I #7: MIGS \/ MIBS SHOWDOWN\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/HdOg26mD7FI?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<p>The <strong>glaucoma<\/strong> it is one of the leading causes of blindness worldwide, and its management has evolved significantly. Today, <strong>minimally invasive glaucoma surgeries (MIGS and MEPS)<\/strong> offer safer and more effective alternatives to control <strong>intraocular pressure (IOP)<\/strong>. This article explores the latest trends and technologies in the field, based on an analysis of the \"SAMUR A-I #7: MIGS\/MIBS SHOWDOWN\" document, with a focus on IOP reduction, safety profile, and patient selection.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h3 class=\"wp-block-heading\">A Paradigm Shift in Glaucoma Treatment<\/h3>\n\n\n\n<p>Traditionally, the <strong>trabeculectomy<\/strong> has been the gold standard for surgical treatment of glaucoma. However, the current landscape has seen a \"radical shift\" toward less aggressive options. <strong>MIGS y MEPS<\/strong> they seek to reduce IOP to moderate ranges (between 10 and 16 mmHg) with a superior safety profile, offering a \"much broader and generally safer therapeutic arsenal than trabeculectomy.\" The goal is to find the perfect balance between IOP reduction and safety, always selecting the <strong>ideal patient<\/strong> for each technique.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h3 class=\"wp-block-heading\">Flow Pathways and Specific Technologies in Glaucoma Surgery<\/h3>\n\n\n\n<p>Minimally invasive glaucoma surgeries are classified according to the flow pathway they seek to optimize:<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">1. Improvement of Trabecular Flow (Natural Route)<\/h4>\n\n\n\n<p>These techniques facilitate the exit of aqueous humor through its natural route: the <strong>schlemm's canal<\/strong> and the <strong>trabecular meshwork<\/strong>.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Implants\/Scaffolds:<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>iStent Family:<\/strong> Implants designed to improve drainage. The latest versions allow for the placement of multiple iStents for greater effectiveness.<\/li>\n\n\n\n<li><strong>Hydrus:<\/strong> A small scaffold inserted into Schlemm's canal to keep it open. Comparative data with the iStent have sparked debate about its superiority.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Tissue Ablation\/Cutting:<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>Trabectome:<\/strong> Uses electrocautery to ablate trabecular tissue.<\/li>\n\n\n\n<li><strong>Goniotomies with Blades (Kahook Dual Blade \u2013 KDB):<\/strong> They allow precise cutting of the fabric.<\/li>\n\n\n\n<li><strong>Bang Bent of Internal Needle Goniotomy (BANG):<\/strong> An \"ingenious and accessible\" technique that uses a bent insulin needle to perform goniotomy. It stands out for its <strong>cost-effectiveness<\/strong>. In combination with the <strong>phacoemulsification<\/strong> (cataract surgery), has demonstrated a 27% reduction in IOP and a 55% reduction in medication use at 6 months.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Extensive Trabeculotomies:<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>Transillumination Assisted Goniotomy (TAG):<\/strong> A <strong>360-degree trabeculotomy<\/strong> which opens the entire canal. It achieves \"quite remarkable\" IOP reductions of approximately 9.3 mmHg. However, it has the highest rate of <strong>transient hyphema<\/strong> (bleeding in the eye), almost 28%, due to the cutting of more tissue.<\/li>\n\n\n\n<li><strong>OMNI:<\/strong> Combine <strong>canaloplasty<\/strong> and trabeculotomy.<\/li>\n\n\n\n<li><strong>Internal AV Microhook:<\/strong> It has shown \"36-month data\", suggesting <strong>durability<\/strong>.<\/li>\n\n\n\n<li><strong>HFDS:<\/strong> With \"impressive 6-year results,\" which \"gives confidence in its durability.\"<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p>It is important to note that there is a clear \"efficacy-safety balance\": a <strong>greater intervention in the trabecular meshwork<\/strong>, as with GAT or Microhook, often entails a <strong>greater IOP reduction<\/strong>, but also a slightly increased risk of hyphema. In addition, if the <strong>Basal IOP is high<\/strong>, the reduction is usually greater in absolute numbers.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">2. Suprachoroidal Flow<\/h4>\n\n\n\n<p>This path creates a <strong>alternative pathway between the choroid and the sclera<\/strong>.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>MiniJet:<\/strong> The device currently available for this route, with \"5-year data\" and a 38% reduction in IOP, in addition to a \"good safety profile.\"<\/li>\n\n\n\n<li><strong>Security Considerations (CyPass Lesson):<\/strong> Removal of the device <strong>CyPass<\/strong> due to long-term endothelial cell loss was a \"hard lesson\" on the importance of long-term follow-up. This emphasized that the <strong>design, material and monitoring<\/strong> of patients for years are vital. The success of the MiniJet suggests that the suprachoroidal approach is viable with the proper design.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">3. Subconjunctival discharge (MIBS)<\/h4>\n\n\n\n<p>These techniques are more similar to trabeculectomy, as they create a <strong>filtration ampoule<\/strong> so that the aqueous humor drains into the subconjunctival space.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Ex-Press Gel Stent, XEN63 and PreserFlo MicroShunt:<\/strong> They achieve \"more powerful\" IOP reductions, sometimes as much as 40-55%, approaching the results of trabeculectomy. (See the PresserFlo chapter by clicking here.) <a href=\"https:\/\/enfoca.com.mx\/eng\/presserflo-latinoamerica\/\">here<\/a>)<\/li>\n\n\n\n<li><strong>Blister Management:<\/strong> Unlike trabecular MIGS, success here depends on the healing of the external conjunctiva. It is frequently used <strong>mitomycin C<\/strong> to prevent excessive scarring and sometimes it is necessary to perform <strong>needling<\/strong> to keep the blister functional.<\/li>\n\n\n\n<li><strong>Complication Profile:<\/strong> They introduce a different complication profile, with a lower risk of hyphema but a higher risk of blister-related problems, such as leakage, hypotonia, or, rarely, infection.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">4. Reduction of aqueous humor production<\/h4>\n\n\n\n<p>These techniques act on the <strong>ciliary body<\/strong>, the \"factory\" of aqueous humor.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Endoscopic Cyclophotocoagulation (ECP):<\/strong> It allows to visualize and treat the ciliary body internally.<\/li>\n\n\n\n<li><strong>Micropuls TSPC:<\/strong> Performs the treatment externally, using a technology that seeks to be \"gentler and safer\" and less destructive than traditional cyclophotocoagulation. They are particularly useful in <strong>very advanced or refractory glaucomas<\/strong>.<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h3 class=\"wp-block-heading\">Key Findings and Future Implications in Glaucoma<\/h3>\n\n\n\n<p>The field of minimally invasive glaucoma surgery has advanced considerably, offering new hope to patients:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Wide and Safe Therapeutic Arsenal:<\/strong> Ophthalmologists have a \"much broader therapeutic arsenal\" at their disposal, which is generally safer than trabeculectomy for controlling IOP within moderate ranges (10-16 mmHg).<\/li>\n\n\n\n<li><strong>Effectiveness-Safety Balance:<\/strong> It is essential to understand that more powerful techniques, such as GAT or MIBS, achieve greater IOP reductions but carry different risks (hyphema or bleb complications).<\/li>\n\n\n\n<li><strong>Crucial Patient Selection:<\/strong> \"Patient selection is crucial.\" Factors such as <strong>PIO basal<\/strong>, the state of the <strong>iridocorneal angle<\/strong>, the <strong>severity of glaucoma<\/strong>, the <strong>age<\/strong> and the presence of <strong>cataract<\/strong> are decisive. They are developing <strong>nomograms<\/strong> to assist in this decision-making.<\/li>\n\n\n\n<li><strong>Long-Term Data and Durability:<\/strong> The experience with CyPass highlights the need for \u201clong-term data always.\u201d <strong>durability<\/strong> and the <strong>cost<\/strong> are essential factors in daily practice.<\/li>\n\n\n\n<li><strong>Continuous Innovation:<\/strong> Innovation continues unabated, with examples such as BANK for its cost-effectiveness, MiniJet validating the suprachoroidal approach, and Micropuls improving safety.<\/li>\n<\/ul>\n\n\n\n<p>Finally, the \"final reflection\" is raised: the role of the <strong>Artificial Intelligence (AI)<\/strong>AI could analyze various patient factors (OCT, medical history, genetics) to \"refine our ability to predict who will respond best to which technique.\" This would lead to <strong>personalization of glaucoma surgery<\/strong> to a new level, with the ability to \u201cpredict individual response being the next big step.\u201d<\/p>\n\n\n\n<p><\/p>","protected":false},"excerpt":{"rendered":"<p>El glaucoma es una de las principales causas de ceguera a nivel mundial, y su manejo ha evolucionado significativamente. Hoy [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":1585,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[9,10],"tags":[127,36,34,123,125,126,14,124,41,26,20,13,27,122],"class_list":["post-1584","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-podcast","category-samur-a-i","tag-ciclofotocoagulacion-trans-escleral","tag-cirugia-ocular","tag-glaucoma","tag-istent","tag-microhook","tag-minijet","tag-oftalmologia","tag-omni","tag-podcast-medico","tag-presserflo","tag-salud-ocular","tag-samureye","tag-tecnologia-medica","tag-xen63"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>MIGS \/ MIBS SHOWDOWN! - ENFOCA<\/title>\n<meta name=\"description\" content=\"Descubre las cirug\u00edas de glaucoma m\u00ednimamente invasivas (MIGS y MIBS): implantes, goniotom\u00edas, flujo supracoroideo y subconjuntival. 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