Department of Ophthalmology, McGill University Health Center, Montreal, Quebec, Canada.
Curr Opin Ophthalmol. 2012 Mar;23(2):96-104. doi: 10.1097/ICU.0b013e32834ff1e7.
There is an increasing interest and availability of micro-invasive glaucoma surgery (MIGS) procedures. It is important that this increase is supported by sound, peer-reviewed evidence. This article will define MIGS, review relevant publications in the period of annual review and discuss future directions.
The results of the pivotal trial comparing a trabecular micro-bypass stent (iStent, Glaukos Corporation, Laguna Hills, CA, USA) combined with phacoemulsification to phacoemulsification alone showed a significantly higher percentage of patients with unmedicated intraocular pressure (IOP) ≤ 21 mmHg, and a comparable safety profile. Initial results are published regarding a second-generation micro-bypass stent (iStent inject, Glaukos Corporation, Laguna Hills, CA, USA), a canalicular scaffold (Hydrus, Ivantis Inc., Irvine, CA, USA) and an ab interno suprachoroidal microstent (CyPass, Transcend Medical, Menlo Park, CA, USA), showing a decrease in mean postoperative IOP. Phaco-Trabectome (Ab interno trabeculectomy Trabectome, NeoMedix Inc., Tustin, CA, USA) was compared to phacotrabeculectomy and showed less IOP reduction, less postoperative complications, and a similar success rate. Similar success rates were found with the comparison of excimer laser trabeculostomy (ELT, AIDA, Glautec AG, Nurnberg, Germany) and selective laser trabeculoplasty. A number of publications review the importance of the location of implantable devices, intraoperative gonioscopy, cost-effectiveness and quality-of-life studies, and randomized clinical trials.
MIGS procedures offer reduction in IOP, decrease in dependence on glaucoma medications and an excellent safety profile. Their role within our glaucoma treatment algorithm continues to be clarified and differs from the role of more invasive glaucoma surgeries such as trabeculectomy or glaucoma drainage devices.
微创青光眼手术（MIGS）的应用日益广泛。重要的是，这种增加应该有可靠的同行评审证据支持。本文将定义 MIGS，回顾年度综述期间的相关文献，并讨论未来的方向。
比较小梁微分流支架（iStent，Glaukos Corporation，加利福尼亚州拉古纳山）联合超声乳化术与单纯超声乳化术的主要试验结果显示，接受治疗的患者中有更高比例的患者无需药物治疗即可达到眼压（IOP）≤21mmHg，安全性相当。第二代微分流支架（iStent inject，Glaukos Corporation，加利福尼亚州拉古纳山）、小梁切开术（Hydrus，Ivantis Inc.，加利福尼亚州欧文）和内眼脉络膜下微支架（CyPass，Transcend Medical，加利福尼亚州门洛帕克）的初步结果已公布，结果显示术后平均眼压降低。与超声乳化小梁切除术（Ab interno trabeculectomy Trabectome，NeoMedix Inc.，加利福尼亚州图森）相比，Phaco-Trabectome 显示出更低的眼压降低、更少的术后并发症和相似的成功率。准分子激光小梁成形术（ELT，AIDA，Glautec AG，纽伦堡，德国）与选择性激光小梁成形术的比较也发现了相似的成功率。许多出版物综述了植入设备位置、术中房角镜检查、成本效益和生活质量研究以及随机临床试验的重要性。
MIGS 手术可降低眼压、减少对青光眼药物的依赖，且具有良好的安全性。其在我们的青光眼治疗方案中的作用仍在不断明确，并与更具侵袭性的青光眼手术（如小梁切除术或青光眼引流装置）不同。
