MIGS Bleeding: Prevention & Management – Surgeons’ Tips
- During minimally invasive glaucoma surgery (MIGS), bleeding can occur.
- Beckman,MD,FACS, OSN CEDARS/ASPENS Debates Editor,explained that MIGS procedures often involve penetrating the trabecular meshwork.A small amount of bleeding is normal, indicating proper placement.
- Buznego emphasized the importance of distinguishing between normal and pathological bleeding.
Navigate the complexities of Minimally Invasive Glaucoma Surgery (MIGS) bleeding with expert insights. Surgeons Carlos Buznego, MD, and I. Paul Singh, MD, deliver actionable guidance to prevent and manage bleeding during and after MIGS procedures. Discover how to distinguish between normal and pathological bleeding, a critical first step toward effective intervention. Learn key strategies, including the use of viscoelastic to maintain intraocular pressure and the rationale behind elevating the head of the bed to reduce episcleral venous pressure. This article provides invaluable advice for ophthalmologists looking to improve patient outcomes.News Directory 3 shares these vital techniques, making them broadly accessible. What innovations in MIGS management are on the horizon?
Expert Insights on MIGS Bleeding Prevention and Management
Updated June 06, 2025
During minimally invasive glaucoma surgery (MIGS), bleeding can occur. Experts carlos Buznego, MD, and I. paul
Singh, MD, offer guidance on managing this potential complication. The surgeons differentiate between expected
bleeding and pathological hemorrhage, providing strategies for prevention and intervention during and after surgery.
Kenneth A. Beckman,MD,FACS, OSN CEDARS/ASPENS Debates Editor,explained that MIGS procedures often involve
penetrating the trabecular meshwork.A small amount of bleeding is normal, indicating proper placement.
Buznego emphasized the importance of distinguishing between normal and pathological bleeding. Pathological bleeding,
often caused by hitting the iris or ciliary body, requires immediate action. He advises stopping the procedure,
withdrawing the device, and using viscoelastic to pressurize the eye.
Maintaining eye pressure with viscoelastic during the procedure helps control bleeding. Beckman noted that a firmer eye
improves visualization and keeps bleeding under control. He suggests placing the viscoelastic to the side of the
blood to push it away from the surgical field.
Buznego also shared a technique to prevent recurrent bleeding after removing the probe: injecting balanced saline
solution to repressurize the eye. Additionally, elevating the head of the bed slightly can reduce pressure in the
episcleral veins and in the eye.
According to Buznego, minor bleeding at the end of surgery usually clears within 24 hours. Rebleeding on day 1 is
rare and typically managed medically.
What’s next
Surgeons should continue to refine their techniques for MIGS bleeding prevention and management to improve patient
outcomes and minimize complications.