MIGS is a group of surgical techniques characterised by a micro-incisional approach, minimal disruption to the eye's normal anatomy, a strong safety profile, and rapid recovery. Procedures are performed through incisions typically under 1.8mm — the same size used in modern cataract surgery — and work by improving the eye's natural drainage pathways or creating new, small drainage channels. Different MIGS devices and techniques target different parts of the outflow pathway: the trabecular meshwork (for example, iStent inject or Kahook Dual Blade goniotomy), Schlemm's canal (Hydrus microstent), or the subconjunctival space (Xen gel stent). The right approach depends on the individual eye's anatomy and the severity of the glaucoma.

MIGS is generally most appropriate for:
Mild to moderate open-angle glaucoma that isn't adequately controlled on maximum tolerated eye drop therapy
Patients undergoing cataract surgery who also have glaucoma — MIGS can often be performed in the same operative session, improving pressure control without a separate procedure
Patients who aren't tolerating, or aren't able to consistently use, their eye drops
Patients who prefer a lower-risk surgical option and don't require the more aggressive pressure reduction trabeculectomy provides
Early glaucoma where a step up from drops is needed before considering more invasive surgery

MIGS generally achieves a more modest reduction in eye pressure than trabeculectomy — commonly in the range of 20–40% from baseline, compared with roughly 40–50% for trabeculectomy — which is why it suits mild-to-moderate cases better than advanced glaucoma needing very low target pressures. Not every patient is a candidate for every type of MIGS device; Dr. Puja Sheth evaluates angle anatomy, glaucoma severity, and clinical history to select the most appropriate approach.

Most MIGS procedures can be performed in combination with cataract surgery (phacoemulsification) through the same small incisions, in the same operative session. For patients who have both a cataract and glaucoma, this combined approach addresses both — improved vision from cataract removal, improved pressure control from the MIGS device — in a single procedure rather than two separate surgeries.

MIGS is typically performed under local anesthesia, usually taking 15 to 30 minutes as a standalone procedure, longer if combined with cataract surgery. Full details of what to expect on the day are on our Patient Info page.

Recovery is generally quicker and less demanding than after trabeculectomy, with functional vision often returning within days. Post-operative eye drops are typically prescribed for 4–6 weeks, and follow-up visits are usually arranged at day 1, 1 week, 1 month, and 3 months to monitor the pressure response. Activity restrictions — avoiding strenuous exercise, swimming, and eye rubbing — generally apply for 1–2 weeks.