What is minimally invasive glaucoma surgery?

Written by: Mr Francesco Stringa
Published: | Updated: 25/09/2023
Edited by: Conor Dunworth

Glaucoma is a common eye condition, that occurs when the optic nerve is damaged. It is often caused by high pressure within the eye, and can lead to blindness if not treated promptly. In our latest article, leading ophthalmologist Mr Francesco Stringa explains minimally invasive glaucoma surgery (MIGS), a group of treatments that are used to treat glaucoma without major surgery.


What is the aim of minimally invasive glaucoma surgery?

High pressure in the eye is the main risk factor for glaucoma. Minimally invasive glaucoma surgery (MIGS) is a group of procedures and devices which aim to reduce and normalise eye pressure. Additionally, as the use of eye drops for treating glaucoma can cause long term side effects and discomfort, MIGS can help to reduce the number of eye drops required to control the pressure. This can improve the quality of life of the patient.


What makes MIGS minimally invasive?

MIGS allows for improvement of the outflow mechanisms of the eye, avoiding major alterations in normal ocular anatomy. Different types of MIGS have different ways of reducing pressure in the eye, but what they have in common is a quicker recovery compared to standard glaucoma surgery (for example, trabeculectomy and “tube surgery”), with minimal additional downtime for patients.


How do MIGS devices reduce pressure in the eye?

MIGS device can reduce the eye pressure in two ways

  1. Ab-externo: by creating an “alternative pathway” for the fluid in excess to be drained into a small blister (called a bleb) under the conjunctiva (the surface of the eye), and under the upper eyelid.
  2. Ab-interno:  by improving the outflow of the natural drainage canal of the eye. This can be achieved with stents (for example, iStents and Hydrus) or by expanding the drainage system with a gel (viscoelastic) that is then naturally reabsorbed.


Is it a safe procedure?

MIGS have an overall better safety profile than conventional glaucoma surgery. They involve less manipulation of the tissues, less follow-up visits and faster recovery. Ab-interno procedures are generally considered to be safer than ab-externo procedures. Common possible side effects are a transient spike of pressure, temporary bleeding and blurry vision. These usually resolve in the first postoperative week or so.



How long does the procedure take, and what’s involved in recovery?

Most MIGS take approximately 20-30 minutes and they are performed under local anaesthesia in the operating theatre. The postoperative period involves a few weeks’ course of antibiotics and anti-inflammatory eye drops. The eyesight might be slightly blurred during the days immediately after surgery. If glaucoma drops are used before surgery, it is generally recommended to continue using the same drops until the follow-up visit with your surgeon, who might consider reducing them gradually over the following weeks.


If you are worried about glaucoma or any other eye conditions, you can book a consultation with Mr Francesco Stringa via his Top Doctors profile today.

By Mr Francesco Stringa

Mr Francesco Stringa is an award-winning consultant ophthalmic surgeon based in Southampton, who specialises in treatment for glaucoma and cataract. His expertise is focused in glaucoma surgery,  glaucoma laser surgery (selective laser trabeculoplasty and laser iridotomy) and minimally invasive glaucoma surgery (MIGS), as well as, standard and advanced cataract surgery and general ophthalmology. He privately practises at Spire Southampton Hospital, while his NHS base is University Hospital Southampton NHS Foundation Trust, where he is the Clinical Lead for Eye theatres.

Mr Stringa is a leading name in the UK and Europe for different types of glaucoma treatment. He has performed over 2,000 surgeries to date, and he works continuously to audit and improve his treatment outcomes. His specialisms include conventional glaucoma surgery, such as trabeculectomy and glaucoma drainage devices, along with new techniques in minimally invasive glaucoma surgery. He performs laser surgery for the treatment of both open angle and closed angle glaucoma.

Mr Stringa is involved in the management of the glaucoma service at the Eye Unit in Southampton, providing high quality care for a population of nearly 2 million people, in one of the busiest tertiary referral centres in the UK. He also has spearheaded various quality improvement projects at Southampton General Hospital, including the introduction of new lasers for the treatment of refractory glaucoma and new minimally invasive glaucoma devices

Mr Stringa is also a cataract surgery expert with outcomes that are higher than the national average, undertaking over 4,000 procedures in both NHS and private practice. He offers a wide range of intra-ocular options for different vision requirements and expectations. He prides himself in his good communication skills, where he is able to empathise with patients as well as providing the highest quality of care while keeping in mind their individual needs.

He is highly qualified, with an MBBS from the University of Pavia in Italy and a Scholarship at the prestigious Almo Collegio Borromeo, which is classified as a ´highly qualified Cultural Institute` by the Ministry of Education, Universities and Research and is the oldest such institution remaining in operation in Italy. He is a member of the Royal College of Ophthalmologists (MRCOphth) and he achieved the Fellowship from the European Board of Ophthalmology in the Subspecialty of Glaucoma (FEBOS-GL). Mr Stringa completed his initial training in ophthalmology at Manchester Royal Eye Hospital, subsequently he underwent two fellowships in Nottingham University Hospital and St Thomas’ Hospital respectively to further specialise in glaucoma

Mr Stringa is an expert in the evaluation of glaucoma surgery outcomes and is actively involved in the improvement of the glaucoma service at his NHS trust. As a result of this, he is regularly invited to talk on such topics at national and international conferences. Furthermore, he is a mentor and teacher of fellows and trainees, and his clinical research frequently features in highly impacted peer-reviewed journals.

Mr Stringa is member of the UK and EIRE Glaucoma Association (UKEGS), the General Medical Council (GMC) and the European Glaucoma Society (EGS), where is part of the Next Generation Partnership. He has won various awards for his clinical practise and research. He won the Runner Up Research Team prize at the Greater Manchester Clinical Research Awards, the Best Abstract Presentation Award from the UKEGS and the Healthcare Leadership Foundations prize at the NHS Leadership Academy Awards. 

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