Combined Cataract Surgery and MIGS
Understanding Combined Cataract Surgery and MIGS
Minimally invasive glaucoma surgery is typically performed during the same operation using corneal micro-incisions; some techniques may use an additional small entry site. During the procedure, we insert a tiny device or create a microscopic pathway to help fluid drain from your eye more easily.
By improving drainage, MIGS lowers the pressure inside your eye, which is the main goal of glaucoma treatment. These procedures usually target the drainage angle inside your eye and require careful examination of that angle before surgery. The devices are designed to be gentle on your eye tissue and cause less trauma than older glaucoma surgeries.
Scheduling only one surgery saves you time, reduces your overall recovery period, and means fewer days away from work or daily activities. You also avoid the stress and expense of two separate procedures.
- One surgery instead of two separate operations
- Single recovery period with one set of restrictions
- Potentially fewer glaucoma medications long term
- Lower cumulative surgical risk compared to two procedures months apart
Not all patients achieve medication freedom, and some may still require future glaucoma treatment.
Several MIGS devices are approved and commonly used during combined surgery in 2025. Different procedures work through different mechanisms to improve fluid drainage and lower eye pressure.
- Trabecular bypass stents that create a pathway through the drainage meshwork
- Excisional or ablational goniotomy or trabeculotomy to remove tissue blocking drainage
- Canaloplasty or viscodilation techniques to open the drainage canal
- Suprachoroidal approaches that create a new drainage route between layers of the eye
- Subconjunctival microshunts for controlled outflow in select cases
Our eye doctor will recommend a specific device based on your type of glaucoma, your eye anatomy, how much pressure reduction you need, and the anatomy of your drainage angle. Not every option is appropriate for every glaucoma type or angle anatomy.
The cataract portion of your surgery remains the same, which means removing the cloudy lens and replacing it with a clear artificial lens. The MIGS portion adds just a few extra minutes to the overall procedure time.
Because we address glaucoma during the same operation, your eye drop regimen after surgery may include additional anti-inflammatory medications for a short period. Your follow-up schedule will also focus on monitoring both your vision clarity and your eye pressure.
Who Benefits from Combined Cataract and MIGS Procedures
If you carry diagnoses of both cataracts and glaucoma, you may be a candidate for combined surgery. Many people develop cataracts as they age, and glaucoma also becomes more common after age sixty.
Candidacy depends on several factors, including your specific type of glaucoma, the anatomy of your drainage angle, the severity of your disease, your target eye pressure, and any prior eye surgeries. For example, angle-closure glaucoma, certain secondary glaucomas, active inflammation, or very advanced disease requiring aggressive pressure lowering may affect whether combined MIGS and cataract surgery is the right choice for you.
When you are a candidate, treating both conditions together optimizes your vision and protects the optic nerve from further damage. You get clearer sight from cataract removal and better pressure control from the MIGS device.
MIGS procedures work best when glaucoma is caught early or is at a moderate stage. These devices provide modest to moderate pressure lowering, which is often enough when the disease has not yet caused severe damage. The amount of pressure reduction we can achieve must match your individual target pressure based on the health of your optic nerve.
- Early-stage glaucoma with minimal optic nerve damage
- Moderate glaucoma that is stable on medications
- Patients whose visual field loss is limited
- Target pressures that match the expected effect of the chosen MIGS procedure
If you already use one or more glaucoma eye drops every day, combined surgery can help reduce or eliminate some of those medications. Many patients find daily drops inconvenient, expensive, or irritating to the eye surface.
MIGS offers a way to control pressure without relying solely on drops. While you may still need some medication after surgery, the burden is often lighter.
Even if your glaucoma is well-controlled on drops now, you might prefer to lower your dependence on medications over the years ahead. Combining MIGS with cataract surgery can achieve that goal.
Fewer medications mean fewer side effects, lower costs, and less worry about missed doses. This benefit appeals to many patients who value simplicity and long-term convenience.
Most candidates for combined surgery are adults over sixty, but age alone does not make you a candidate or rule you out. We also evaluate your general health, any other eye conditions, and your ability to tolerate a slightly longer procedure.
- Good overall health with stable chronic conditions
- No active eye infections or severe inflammation
- Realistic expectations about pressure reduction
- Willingness to attend regular follow-up visits
How We Determine If You Are a Candidate
We measure your intraocular pressure at every visit using a quick, painless test called tonometry. Tracking your pressure over time helps us understand how well your current treatment is working and whether additional intervention makes sense.
If your pressure remains above target despite medications, or if we see fluctuations that could harm the optic nerve, combining MIGS with your cataract surgery may offer better control.
Visual field testing maps your side vision to detect any blind spots caused by glaucoma. You look into a machine and press a button each time you see a light, and the computer analyzes the pattern of your responses.
Results help us stage your glaucoma and decide whether a MIGS device will provide enough pressure lowering. Severe visual field loss may require a more aggressive surgical approach instead.
We examine your optic nerve using a special microscope and often take high-resolution images with optical coherence tomography. These images reveal thinning of the nerve tissue and help us track any changes over time.
- Detection of optic nerve cupping or thinning
- Baseline imaging to compare future scans
- Assessment of nerve health before surgery
Not every cataract needs immediate surgery, so we evaluate how much the cloudiness affects your daily life. If your vision is good enough for safe driving and reading, we may recommend waiting.
When the cataract is ready for removal and you also have glaucoma, that is the ideal moment to combine procedures. We align the timing to benefit both conditions.
We review every glaucoma drop you use, how well your pressure is controlled, and any side effects you experience. If you use multiple drops or struggle with the regimen, MIGS becomes more appealing.
Understanding your medication history also helps us predict how much additional pressure lowering you might need and which MIGS device will work best.
Your overall medical history matters because certain conditions can affect healing or increase surgical risk. We ask about diabetes, autoimmune diseases, blood thinners, and any previous eye surgeries or injuries.
- History of other eye surgeries or trauma
- Current medications, including blood thinners
- Chronic conditions like diabetes or arthritis
- Allergies to anesthesia or eye drop ingredients
What to Expect During Combined Surgery
Your surgeon may prescribe preoperative drops depending on protocol; antisepsis on the day of surgery is standard. You will receive detailed instructions about which medications to take or skip on the morning of surgery and when to stop eating or drinking.
Arrange for someone to drive you home afterward, since your vision will be blurry and you cannot drive the same day. Wear comfortable clothing and leave jewelry and valuables at home.
You will lie comfortably on a reclining surgical bed while we clean the area around your eye and apply sterile drapes. A microscope helps us see the tiny structures inside your eye as we work.
First, we remove the cloudy cataract through a small incision and insert the new artificial lens. Then, using the same or a nearby incision, we place the MIGS device or create the drainage pathway. Throughout the procedure, you remain awake but relaxed.
Most patients receive numbing eye drops and a mild sedative to keep you calm and comfortable. You will not feel pain during the surgery, though you may sense light pressure or hear quiet sounds from the instruments.
- Topical anesthetic drops numb the eye surface
- Light sedation through an intravenous line keeps you relaxed
- Some surgeons may use injection-based anesthesia depending on the case
Cataract surgery alone typically lasts fifteen to twenty minutes. Adding the MIGS portion extends the total time by only a few minutes, so the entire combined procedure usually finishes in under thirty minutes.
After surgery, you rest briefly in a recovery area while the sedation wears off, and then you go home the same day. There is no overnight hospital stay required.
Risks, Side Effects, and Limitations
Many patients experience mild and temporary side effects in the first days or weeks after combined surgery. These effects are usually manageable and improve as your eye heals.
- Transient blurred vision or fluctuating vision clarity
- Hyphema, or a small amount of blood in the front chamber of your eye
- Light sensitivity and glare or halos around lights
- Foreign-body sensation or mild discomfort
- Transient eye pressure elevation or fluctuation
Although rare, more serious complications can occur with any eye surgery. We monitor you closely to detect and manage these issues early if they arise.
- Infection inside the eye, known as endophthalmitis
- Persistent inflammation or swelling
- Corneal edema or risk of corneal decompensation in susceptible eyes
- Significant or prolonged eye pressure spike
- Device obstruction, malposition, or migration
- Peripheral anterior synechiae or angle closure
- Choroidal effusion or hemorrhage
- Need for additional glaucoma surgery
- Vision-threatening complications, though very rare
MIGS procedures offer many benefits, but they also have limitations. Understanding what these devices can and cannot achieve helps set realistic expectations.
Pressure reduction with MIGS is often modest to moderate rather than dramatic. Results vary by device, individual anatomy, and healing response. Some patients will continue to need glaucoma medications after surgery, and others may require additional glaucoma procedures in the future if pressure rises or the disease progresses.
Recovery and Follow-Up Care After Combined Surgery
Your vision will be blurry immediately after surgery, and you may see halos around lights or notice mild redness. These effects improve quickly over the first day or two as your eye begins healing.
Mild discomfort, a gritty feeling, or light sensitivity are normal. Resting with your head elevated and wearing the protective shield we provide, especially while sleeping, helps protect your eye during this early phase.
We prescribe antibiotic drops to prevent infection and anti-inflammatory drops to reduce swelling. You may also continue or adjust your glaucoma medications depending on your pressure readings after surgery.
- Use drops exactly as prescribed, even if your eye feels fine
- Wait at least five minutes between different drop types
- Wash your hands before touching the bottle or your eye area
- Keep track of doses with a written schedule if needed
Avoid heavy lifting, bending over, or straining for at least one week, since these activities can raise eye pressure temporarily. You should also skip swimming, hot tubs, and dusty or dirty environments until we clear you, typically one to two weeks after surgery.
Most patients return to light activities like reading or watching television within a day or two. Driving is allowed once your vision is clear enough and we confirm it is safe, often within a few days to a week.
Your first follow-up visit usually happens within one to two days after surgery. We check your vision, measure your eye pressure, and examine the surgical site to ensure everything is healing properly.
Additional visits occur over the next few weeks and months to monitor pressure trends and adjust medications if needed. Long-term success depends on keeping your pressure in a safe range and watching for any signs of glaucoma progression.
Although serious complications are rare, certain symptoms require urgent evaluation. Call our office immediately or seek urgent or emergency evaluation if you notice any of these warning signs.
- Sudden decrease in vision or new floaters and flashes
- Severe eye pain or headache
- Worsening pain with worsening vision that does not improve day to day
- Increasing redness, swelling, or discharge
- Marked light sensitivity or a cloudy or hazy cornea
- Nausea or vomiting along with eye discomfort
Frequently Asked Questions
Adding MIGS to cataract surgery does introduce certain additional risks, though the overall safety profile remains favorable for most patients. You may have a higher chance of temporary bleeding in the front of the eye, short-term eye pressure fluctuations, or inflammation compared to cataract surgery alone. The specific risks depend on the type of MIGS device or technique we use and your individual eye anatomy. We will discuss these risks with you so you can make an informed decision.
Many patients can reduce the number of glaucoma medications they use after combined surgery, but not everyone can stop drops entirely. The amount of pressure lowering varies by device and individual anatomy, so we monitor your pressure closely and adjust medications to keep you in a safe range.
Most MIGS devices provide sustained pressure reduction for several years, though the exact duration varies by procedure, device, and individual healing. Some patients maintain good pressure control for five years or longer, while others may see a gradual rise over time due to scarring, obstruction, or disease progression. Durability varies, and some eyes need additional treatment earlier. Regular follow-up helps us catch any changes early and adjust treatment if needed.
MIGS procedures are generally most effective for mild to moderate glaucoma. If your disease is advanced with significant optic nerve damage or very high pressures, we may recommend a more traditional glaucoma surgery instead. Each case is unique, so we tailor our recommendation to your specific situation.
If your pressure remains above target after combined surgery, we have several options. We can add or increase glaucoma medications, consider laser treatment to enhance drainage, or discuss a second glaucoma procedure if necessary. The goal is always to protect your optic nerve and preserve your vision long term.
Several alternatives exist depending on your individual situation. You may choose cataract surgery alone, which can lower eye pressure modestly in some patients. Continuing or adjusting glaucoma eye drops is another option, as is selective laser trabeculoplasty to improve drainage. For more advanced glaucoma, traditional filtering surgery such as trabeculectomy or a tube shunt may be more appropriate. Some patients prefer a staged approach, having cataract surgery first and then a separate glaucoma procedure if needed later. We will review all suitable options with you.
Getting Help for Combined Cataract Surgery and MIGS
If you have both cataracts and glaucoma, our eye doctor can evaluate whether combined surgery is right for you. We will review your eye health, discuss your treatment goals, and create a personalized plan to protect your vision and simplify your care.