Ashley Porter1, Graham Lee1,2

Micro-invasive Glaucoma Surgery (MIGS) has been a recent innovation to the glaucoma armamentarium. The role lies somewhere in between medical/laser therapy and glaucoma drainage surgery with trabeculectomy and tubes. It has been promoted as minimally invasive surgery, used standalone or in conjunction with cataract surgery. The procedure requires skills in surgical gonioscopy, however once mastered allows for an efficient, stress-free placement of the stent…..yeah right!

MIGS is not always the fun, quick solution to intraocular pressure nirvana. Difficult patient positioning, topical anaesthesia, anti-coagulation, peripheral anterior synechiae, friable trabecular meshwork, bleeding… oh did I mention BLEEDING etc are all challenges to overcome on the steep learning curve. Some of these issues do improve with experience, but some just hit you out of the blue when you least expect it.

This video presents some of the trials and tribulations of this wonderful recent technology of MIGS. It will address potential solutions, but may raise other issues. We quote Ralph Emerson when we say, “Bad times have a scientific value. These are occasions a good learner would not miss.”