New procedures

There are a variety of newly proposed procedures to treat glaucoma, most of them involving ways to improve outflow of aqueous by treating the meshwork. The aim of some of the new procedures is to do less to achieve more, so they are called minimally invasive glaucoma surgery (MIGS). One of these is a technique called the Trabectome that can improve aqueous outflow and lower pressure by removing a thin layer of trabecular tissue. A second type of such treatments called canaloplasty and GATT theoretically widen or open the canal from which aqueous humor leaves the eye. A third new procedure called iStent puts a tiny metal tube inside the eye into the trabecular meshwork to improve its flow. There are several more such procedures that are in various stages of research, but have not been approved by the FDA. None of these procedures is so much better than trabeculectomy that they have become the procedure of choice, though each has some positive aspects. Most of them lower the pressure somewhat, but not a lot. Those manufacturing and testing these MIGS procedures have avoided direct studies comparing them to trabeculectomy or tube shunt surgery.

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