Laser/MIGS in myopic glaucoma

Abstract

Myopic glaucoma represents a therapeutic challenge, especially if due to the lack of adequate pharmacological pressure control surgery becomes necessary. Issues such as thin sclera and an increased risk of choroidal haemorrhage postoperatively make it difficult to offer an “one size fits all” solution. The standard method of trabeculectomy is burdened with additional risks, in comparisons to non‐myopic glaucomatous eyes. MIGS, such as XEN, and implants such as PreserFlo, have opened new more standardized avenues for filtering procedures, but still carry an increased risk of complications. Several years ago a modification of cyclodestructive procedure, micropulse transcleral laser therapy, has been introduced and since then used for the intermediate levels of intraocular pressure reduction. When faced with operative risks mentioned above, this laser method, combined with continued application of pharmacological therapy, can achieve reasonable levels of intraocular pressure reduction with an, in comparison to alternative methods, unprecedented levels of safety.