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Monday / May 20.
HomeminewsAustralian First Rural MIGS Procedure Performed

Australian First Rural MIGS Procedure Performed

In an Australian first, ophthalmologists have used Minimally Invasive Glaucoma Surgery (MIGS) to treat four glaucoma patients on the ground in outback Australia.

Glaucoma surgeon Dr. Ashish Agar, one of the first ophthalmologists in Australia to perform MIGS, performed the surgery in Broken Hill. He is the Glaucoma subspecialist of the Outback Eye Service team based at Prince of Wales Hospital in Sydney, and Director of the Ophthalmology Service at Broken Hill Base Hospital.

He said the MIGS procedure would fill a gap in treatment options for glaucoma patients in rural and remote Australia.

“When we treat patients for glaucoma, our first line of treatment is using drops or laser treatment and this is fine for many, but when it stops working and patients are at risk of going blind, we have to look at alternatives,” said Dr. Agar.

This is a boon for equity of access to specialist medical services for people living in the bush

While trabeculectomy remains the gold standard for most patients who are nonresponsive to drops and laser, it does not suit some because of their disease state, comorbidities or their remote location.

“Trabeculectomy is challenging in outback Australia because it is a major, complex operation and its success or failure is based on intensive post-operative care. This process requires frequent visits to the ophthalmologist, up to twice a week, and continues for several months. Also, we often need additional procedures, such as antimetabolite injections into the eye, suture manipulation and laser,” said Dr. Agar.

“I believe MIGS can really provide a ray of hope for these patients who are losing vision due to glaucoma,” said Dr. Agar. “It’s taken a while but we’re finally able to use MIGS to treat these patients in remote area settings.”

Dr. Agar preferred the Hydrus microstent (Avantis) for the first MIGS procedures in remote Australia because he had been using the technology for four years and as such, felt it was a “tried and true” operation in his hands. He said the principle of the Hydrus is to bypass the major obstruction – the trabeculum – by three mechanisms. Firstly it allows direct aqueous flow into the Schlemms canal; it acts as a scaffold for the meshwork to increase the size of Schlemms canal by up to a factor of five, and lastly its extent enables it to treat a quarter of the angle – it has the potential to increase the aqueous outflow channel significantly. Further, it is especially effective when performed as a standalone operation, not combined with cataract surgery.

Dr. Agar treated four patients, all with advancing glaucoma and one also for significant cataract. The option of standalone surgery for glaucoma was important as these patients were pseudophakic, which meant cataract surgery was not required. “Before today, rural and remote glaucoma patients could not access this advanced technology in their own communities, despite the fact that its outcomes can be transformational,” he said. “This is a boon for equity of access to specialist medical services for people living in the bush. It also represents major progress in the treatment of glaucoma in Australia.”


Broken Hill Hospital management has worked working closely with Prince of Wales Hospital for a number of years to build a unique public specialist eye service at the hospital and they worked closely with Dr. Agar to facilitate use of the technology in the bush. Broken Hill Health Services Director of Medical Services, Dr. André Nel said the MIGS outreach clinic demonstrated the power of partnerships.

“Bringing specialist medical services to the bush is a priority for Broken Hill Hospital and this exciting new development is testament to the dedication and hard work of our staff and the work of our partners at The Outback Eye Health Service,” he said.

“We are proud to be taking part in this revolutionary surgery on our patch. It paves the way for more ventures that will deliver exciting benefits to local patients.”

Ivantis, the medical device company who created the Hydrus Microstent used in the surgeries, was integral in enabling this Australian first. “From the outset, Ivantis has been exceptionally supportive in allowing our patients access to their technology,” said Dr. Agar.

“They have donated many of their devices to those who cannot afford them, including here in Broken Hill where all of the microstents were provided free of charge to the patients.”