Updated list of applicable CPT codes to reflect annual edits; added 1012T.
Added notation that specific CPT/HCPCS codes are not on the State of North Carolina Medicaid Fee Schedule and therefore may not be covered by the State of North Carolina Medicaid Program.
Archived previous policy version CSNCT0443.03.
≥20% IOPMIGS benefit threshold
5 yearsHydrus outcomes reported
36 monthsiStent inject outcomes
5 yearsEX-PRESS follow-up
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NC
Applicable state
1012TCPT/HCPCS change
Coverage Criteria and Evidence
Covered procedures and primary indications
The following procedures are considered proven and medically necessary under the specified conditions:
Pediatric indication: Goniotomy or trabeculotomy for pediatric glaucomaage ≤18 years
Pediatric surgical indication supported by policy text.
Adult combined cataract indication: Goniotomy, trabeculotomy, ab-interno canaloplasty, or combined ab-interno canaloplasty and trabeculotomy (e.g., OMNI, Streamline) when performed in combination with cataract surgery for treatment of mild to moderate open-angle glaucoma and cataract in adults currently treated with ocular hypotensive medicationage ≥19 years; combined with cataract surgery; mild–moderate OAG; on ocular hypotensive medication
Device/procedure context and patient population specified in policy.
Trabecular microstents with cataract: Trabecular microstents (iStent, iStent inject, Hydrus Microstent) when used in combination with cataract surgery for treatment of mild to moderate open‑angle glaucoma and cataract in adults currently treated with ocular hypotensive medicationcombined with cataract surgery; mild–moderate OAG; on ocular hypotensive medication
Device-specific approved use described in policy.
Glaucoma drainage devices for refractory disease: Glaucoma drainage devices (e.g., XEN System, EX-PRESS, Molteno, Baerveldt, Ahmed, Krupin‑Denver) for treating refractory glaucoma when medical or prior surgical treatments have failed or are inappropriaterefractory glaucoma after failed or inappropriate medical/surgical treatments
Indication for aqueous shunts and similar devices described in policy.
Laser procedures covered: Laser trabeculoplasty (argon or selective), laser iridotomy/iridectomy (Nd:YAG), laser iridoplasty, and laser ciliary body destruction are considered proven and medically necessary for appropriate indications
Listed laser procedures considered proven and medically necessary per policy.
Clinical evidence–based coverage considerations
Evidence-based considerations when evaluating coverage for microstent implantation with cataract surgery or standalone MIGS:
Hydrus with cataract surgery: Randomized trials and evidence reviews report Hydrus plus cataract surgery reduces IOP and medication use compared with cataract surgery alone with benefit reported up to 5 years; consider in adults with mild–moderate OAG and cataract when additional IOP lowering is desiredfollow-up reported up to 5 years
ECRI review and long‑term HORIZON outcomes summarized.
iStent / iStent inject: Pivotal randomized trials show iStent inject implanted with cataract surgery yields greater proportions achieving ≥20% unmedicated IOP reduction and higher medication‑free rates versus cataract surgery alone; safety profiles in trials were favorable24‑ to 60‑month follow-up reported in studies
Samuelson pivotal RCT and systematic reviews included.
Comparative device considerations:
Evidence-based coverage considerations
Evidence summaries and limitations relevant to coverage decisions:
Laser peripheral iridoplasty (LPIp): Small RCTs and systematic reviews show LPIp combined with peripheral iridotomy can improve anterior chamber angle metrics but do not demonstrate consistent additional IOP reduction versus iridotomy alone; trials are small and at high risk of biaslimited/high risk of bias evidence
Cochrane and Qin et al. RCTs summarized.
Cyclodestructive procedures: Evidence comparing cyclodestructive procedures with other interventions for refractory glaucoma is inconclusive; reported adverse events include hypotony and phthisis bulbi and larger, well‑designed RCTs are neededinconclusive evidence
Cochrane review findings.
Ab‑interno canaloplasty and combined canaloplasty/trabeculotomy (OMNI, Streamline): Interim RCT data and multiple case series report reductions in IOP and medication use up to 12 months, but comparative effectiveness versus other MIGS or standard surgeries is not established due to low‑quality or uncontrolled studies
Summarized effectiveness evidence groups
Study populations and outcome definitions used in referenced evidence:
OMNI (combined canaloplasty + trabeculotomy) clinical findings: Case series and single‑arm studies report large proportions achieving ≥20% IOP reduction and substantial medication reduction at 6–12 months (e.g., 84.2% eyes with >20% IOP reduction, 80% medication‑free at 12 months in one series); common adverse events include transient hyphema and transient IOP elevations; studies lack control groups and have short follow‑up6–12 month outcomes
GEMINI and other OMNI reports.
KDB (excisional goniotomy) findings: Systematic reviews and RCTs report KDB combined with phacoemulsification produces greater early IOP and medication reduction versus phaco alone and may outperform first‑generation iStent in some analyses, though heterogeneity and study quality limit strong conclusions; common AEs include hyphema and transient IOP spikes12–24 month outcomes
Radwan meta-analysis and Falkenberry RCT data.
Coverage decision criteria
Evidence-based considerations and device-specific indications to guide coverage decisions:
Device indication for use: Confirm device FDA approval status and that the requested use matches approved context (e.g., Hydrus and iStent approvals specify use in conjunction with cataract surgery); standalone use of devices approved only with phacoemulsification should be treated as off‑label and require strong justification
FDA approvals and device PMA/K‑numbers referenced in policy.
Clinical effectiveness evidence threshold: Coverage is supported when there is sufficient evidence of clinically meaningful IOP reduction and/or reduction in glaucoma medication burden from randomized trials or high‑quality comparative studies; devices/procedures supported only by single‑arm or small retrospective studies require additional justification and may be subject to prior authorization or case review
AAO guidance and policy evidence summaries inform this threshold.
When filtration/shunt preferred: Consider trabeculectomy or aqueous shunt procedures when target IOP requires greater lowering than typically achieved with MIGS (e.g., pressures in the low to mid‑teens or lower) or when prior incisional surgery makes aqueous shunts the more effective option
The policy states that all other FDA‑approved types of laser procedures not specifically enumerated as covered are considered unproven and not medically necessary for treating glaucoma due to insufficient evidence of efficacy and/or safety. This exclusion applies to laser procedures beyond the listed covered lasers (e.g., argon/SLT trabeculoplasty, Nd:YAG iridotomy, iridoplasty, and ciliary body destruction) and reflects the document's assessment that evidence quality is inadequate to support broad coverage for other laser modalities.
The excerpt does not provide a catalog of explicit administrative exclusions beyond the statement that many procedures lack sufficient evidence; instead it emphasizes study limitations and heterogeneity (small sample sizes, short follow‑up, and variable study designs) that constrain generalizability and may limit indications for some procedures. These evidence limitations should be considered when evaluating requests for laser or novel MIGS interventions.
One randomized trial comparing Baerveldt tube implantation versus trabeculectomy explicitly excluded eyes with a narrow anterior chamber angle interfering with tube implantation. Narrow anterior chamber anatomy may therefore be considered a procedural exclusion or a factor limiting the suitability of tube shunt placement in some patients.
The policy identifies procedures with inconclusive evidence: argon laser peripheral iridoplasty (LPIp) has not demonstrated consistent additional IOP reduction versus peripheral iridotomy in pooled RCT data, and cyclodestructive procedures (cyclophotocoagulation) have inconclusive comparative evidence and carry risks such as hypotony and phthisis bulbi. These modalities should be considered investigational or used with caution pending higher‑quality comparative trials.
No discrete procedural exclusions (i.e., an itemized list of banned procedures) are provided in this segment; rather, the document repeatedly notes limitations in the evidence base for many procedures. Those limitations—lack of randomized comparative trials, small cohorts, or short follow‑up—inform conservative coverage judgments and may prompt review or denial absent stronger clinical justification.
Several laser treatments discussed in the evidence section (for example, excimer laser trabeculostomy/ trabeculotomy [ELT], femtosecond laser trabeculotomy [FLT], and OCT‑guided laser trabeculotomy) are not FDA‑approved for glaucoma treatment in the U.S. and have limited or single‑arm study data; the policy concludes that available evidence is insufficient to establish safety and efficacy for many of these laser techniques.
The policy history notes that specific CPT/HCPCS codes (including 0253T, 0449T, 0450T, 0474T, 0621T, 0622T, 0671T, 0730T, 1012T, 66175, and L8612) are not on the State of North Carolina Medicaid Fee Schedule and therefore may not be covered by NC Medicaid. Providers should confirm state fee schedule inclusion and coverage prior to submission.
The document positions MIGS as interventions intended for patients with mild to moderate open‑angle glaucoma—typically those on ocular hypotensive medications—and specifically notes they are not appropriate for advanced disease requiring very low target IOP. MIGS aim for at least a 20% IOP reduction or reduction of one medication, and their lower complication profile must be balanced against generally more modest IOP‑lowering compared with trabeculectomy or aqueous shunts.
Within the provided excerpt the authors do not issue standalone 'not medically necessary' proclamations for the devices covered; instead, they highlight areas of uncertain added benefit and evidence gaps. Coverage determinations for specific devices should therefore rely on the explicit covered indications and the quality of supporting evidence rather than a blanket non‑coverage statement in this segment.
Argon laser peripheral iridoplasty (LPIp) used as an adjunct to peripheral iridotomy has limited RCT evidence and pooled analyses do not show a clear additional IOP‑lowering benefit. The policy cites the Cochrane review concluding LPIp may improve anterior chamber morphology but does not demonstrate significant IOP reduction versus iridotomy alone.
A randomized single‑center trial reported no statistically significant additional benefit of KDB combined with phacoemulsification (phaco‑KDB) over phacoemulsification alone at 12 months for IOP or medication reduction in that small study, illustrating instances where added MIGS procedures may not improve short‑term outcomes versus cataract surgery alone.
The policy flags several procedures supported primarily by small, single‑arm, or short‑term studies without randomized comparisons (for example, FLIGHT, some ELT series, and OCT‑guided approaches). Because randomized or long‑term comparative data are lacking, these techniques are characterized as investigational or of uncertain benefit until higher‑quality evidence is available.
Procedure Codes, Coding Notes and Thresholds
Referenced procedure codesmixed
0253T
Insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach, into the suprachoroidal space.
0449T
Insertion of aqueous drainage device, without extraocular reservoir, internal approach, into the subconjunctival space; initial device.
0450T
Insertion of aqueous drainage device, without extraocular reservoir, internal approach, into the subconjunctival space; each additional device (List separately in addition to code for primary procedure).
0474T
Insertion of anterior segment aqueous drainage device, with creation of intraocular reservoir, internal approach, into the supraciliary space.
0621T
Trabeculostomy ab interno by laser.
0622T
Trabeculostomy ab interno by laser; with use of ophthalmic endoscope.
0671T
Insertion of anterior segment aqueous drainage device into the trabecular meshwork, without external reservoir, and without concomitant cataract removal, one or more.
0730T
Trabeculotomy by laser, including optical coherence tomography (OCT) guidance.
1012T
Motorized ab interno trephination of sclera (sclerostomy), or trabecular meshwork (trabeculostomy), 1 or more, including injection of antifibrotic agents, when performed.
65820
Goniotomy.
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Devices and procedures discussed (codes not listed)mixed
No explicit CPT/HCPCS/ICD codes in this excerpt
Document text provides device and procedure names (e.g., iStent, iStent inject, Hydrus Microstent, EX-PRESS, Molteno, Baerveldt, Ahmed, Krupin-Denver, OMNI, Streamline, KDB, GATT, Trabectome) but does not list billing codes in these sections.
Coding referenced (none specified)mixed
No specific CPT/HCPCS/ICD-10 codes listed in this document excerpt.
FDA device predicate and PMN/PMA identifiersmixed
K062259
Canaloplasty Ophthalmic Microcannula (iTRACK) - FDA PMN.
K211680
Streamline Surgical System (Streamline Viscoelastic Injector) - FDA K-number.
K030350
EX-PRESS Mini Glaucoma Shunt - FDA 510(k) approval (K030350).
K161457
XEN Glaucoma Treatment System - FDA K-number (K161457).
P170043
iStent inject PMA number (P170043).
GTS100R/L
iStent Model identifier (GTS100R/L) - FDA-approved device (approved 2012).
P170034
Hydrus Microstent PMA number (P170034).
K230722
Eagle laser device - FDA K-number (K230722).
K140336
OPTIMIS FUSION Ophthalmic Laser Systems family - FDA K-number (K140336).
Codes called out in Policy HistoryCPT | HCPCS
0253T
Listed in policy history as not on NC Medicaid Fee Schedule.
0449T
Listed in policy history as not on NC Medicaid Fee Schedule.
0450T
Listed in policy history as not on NC Medicaid Fee Schedule.
0474T
Listed in policy history as not on NC Medicaid Fee Schedule.
0621T
Listed in policy history as not on NC Medicaid Fee Schedule.
0622T
Listed in policy history as not on NC Medicaid Fee Schedule.
0671T
Listed in policy history as not on NC Medicaid Fee Schedule.
0730T
Listed in policy history as not on NC Medicaid Fee Schedule.
1012T
Added to applicable CPT codes list (policy revision 05/01/2026).
66175
Listed in policy history as not on NC Medicaid Fee Schedule.
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MIGS efficacy threshold
MIGS efficacy thresholdMIGS should provide ≥20% reduction in intraocular pressure (IOP) or a reduction of at least one glaucoma medication.
Intended severity groupTypically indicated for mild to moderate open‑angle glaucoma; not appropriate for advanced disease requiring very low target IOP.
Typical surgical contextOften performed via an ab interno approach and frequently combined with phacoemulsification (cataract surgery).
Prior Authorization, Documentation, and Clinical Workflow
Prior Authorization
Prior Authorization Required
Prior Authorization Required. Verify member's benefit and plan-specific prior authorization requirements before scheduling; prior authorization may be required for MIGS, microstents, canaloplasty, trabeculotomy, and glaucoma drainage device procedures depending on the contract and state Medicaid rules.
Check member benefit plan and state-specific rules (e.g., North Carolina Medicaid may not cover certain CPT/HCPCS codes listed in this policy).
If prior authorization is required, document device model and FDA indication (e.g., iStent/iStent inject, Hydrus approved only with concurrent cataract surgery).
For standalone use of devices approved only with cataract surgery (off-label), expect additional review or likely denial.
Documentation Required
Documentation Required
Document clinical rationale and required data in the chart to support medical necessity. Include diagnosis, prior medical therapy, treatment goals, and procedure-specific justification.
Clinical Background and Scope
Background: Glaucoma comprises progressive optic neuropathies associated with elevated intraocular pressure (IOP) that can lead to visual field loss. Disease severity is staged clinically (mild, moderate, severe) and guides therapeutic selection. The policy distinguishes procedures by anatomic approach and intent—MIGS (ab interno, often combined with cataract surgery) are positioned for mild‑to‑moderate disease, whereas glaucoma drainage devices and filtration surgery are reserved for refractory or advanced disease requiring greater IOP lowering.
Definitions and Device Descriptions
MIGS: definition and characteristics
DefinitionMicroinvasive glaucoma surgery (MIGS) is a group of minimally invasive ab‑interno procedures that minimize disruption of ocular anatomy to lower IOP.
Key characteristicsPerformed via ab‑interno approach, lower complication risk than traditional filtering surgery, but generally produce more modest IOP reduction.
Typical indication/contextOften combined with cataract (phacoemulsification) in adults with mild to moderate OAG on ocular hypotensive medication.
Updated list of applicable CPT codes to reflect annual edits and added code 1012T to the policy's applicable codes list.
2026-05-01State Medicaid coverage note added
Noted that specific CPT/HCPCS codes (0253T, 0449T, 0450T, 0474T, 0621T, 0622T, 0671T, 0730T, 1012T, 66175, and L8612) are not on the North Carolina Medicaid Fee Schedule and therefore may not be covered by NC Medicaid.
Policy Summary
PayerUnitedHealthcare
PolicyGlaucoma Surgical Treatments (for North Carolina Only)
Policy CodePolicy CSNCT0443.04
Change TypeCode list updatedNC Medicaid coverage note added
Effective DateMay 1, 2026
Next Review DateN/A
Key ActionVerify plan/contract for prior authorization requirements and confirm whether listed CPT/HCPCS codes are covered by North Carolina Medicaid.
Network meta-analyses and comparative reviews indicate multi‑stent strategies or Hydrus may have greater effect than single iStent when combined with phacoemulsification, but heterogeneity and low‑quality evidence limit firm comparative conclusions
uncertain comparative advantage
Meta-analyses show variability and focal anterior synechiae more frequent with Hydrus.
EX-PRESS vs trabeculectomy: Randomized trials and meta-analyses report EX-PRESS implantation provides comparable or better complete success rates at 1 year (and reported through extended follow-up) with fewer certain complications and less postoperative intervention compared with trabeculectomyoutcomes reported to 1–5 years
Sun et al. meta-analysis of RCTs.
Pediatric angle surgery evidence: Case series support goniotomy as an effective initial surgical treatment in juvenile open‑angle glaucoma, but comparative evidence is limited and sample sizes are smallsmall sample sizes; limited comparative data
Retrospective pediatric series summarized in policy.
12‑month outcomes; lack of high‑quality comparative data
VENICE interim results and GEMINI/OMNI case series cited; prior authorization documentation may be warranted.
GATT and other ab‑interno trabeculotomy findings:
Case series and retrospective studies report IOP and medication reductions with GATT, including in secondary glaucomas, with frequent hyphema and variable long‑term control; randomized controlled trials are lacking
variable follow‑up up to 24 months
GATT case series and retrospective reports.
AAO preferred practice patterns and comparative evidence on aqueous shunts vs trabeculectomy summarized.
History of ocular hypertension/glaucoma subtype and severity (mild, moderate, refractory) and pre-procedure IOP measurements (including diurnal or washout values when available).
Current glaucoma medication regimen and prior response; attempts at medical therapy and any intolerance or inadequate control.
For procedures combined with cataract surgery, document concurrent cataract indication and that patient is currently on ocular hypotensive medication if device FDA labeling requires it (e.g., iStent, Hydrus).
Specify device name/model and whether FDA-approved indication matches planned use (e.g., Hydrus, iStent inject approved only with cataract surgery).
Step Therapy
Step Therapy and Treatment Sequencing
Clinical sequencing and step therapy considerations. Consider less invasive options and guideline-recommended sequencing prior to surgical MIGS in appropriate patients.
Consider selective laser trabeculoplasty (SLT) as initial therapy or adjunctive treatment for POAG/OHT; document SLT attempt or rationale for bypassing it.
Document reason for choosing MIGS over traditional filtering surgery (e.g., target IOP, comorbidities, surgical risk) and whether patient requires low target IOP that may necessitate trabeculectomy or aqueous shunt.
There is no mandated step-therapy specifying MIGS before trabeculectomy/aqueous shunts — clinical judgment and documented rationale are required.
Prior Authorization
Device-Specific Verification
Device-specific review recommended. Confirm FDA approval status and intended use of the implanted device; some approvals are limited to use only in combination with cataract surgery.
iStent (2012) and iStent inject (PMA 2018) are approved only for use in combination with cataract surgery; standalone implantation is off-label.
Hydrus Microstent approved for use with cataract surgery in mild to moderate POAG.
XEN Glaucoma Treatment System and other aqueous shunts have FDA approvals; indicate when device is intended for refractory glaucoma.
For newer or less-evidenced devices (e.g., canaloplasty tools, OMNI, Streamline), include supporting clinical evidence and indicate whether the procedure is being performed concomitantly with phacoemulsification.
Billing Rule
Coverage & Coding Verification
Coverage and coding: listing of a code in this policy does not imply coverage. Verify whether CPT/HCPCS codes planned for billing are on the member's state Medicaid fee schedule or covered by the benefit.
Confirm whether CPT/HCPCS codes (including *0253T, *0449T, *0450T, *0474T, *0621T, *0622T, *0671T, *0730T, *1012T, 66175, and L8612) are covered by the member's state Medicaid program; codes marked with * may not be on North Carolina Medicaid Fee Schedule.
If site-of-service restrictions apply (see related Outpatient Surgical Procedures - Site of Service policy), confirm appropriate facility setting and billing modifiers as needed.
Denial Risk
Denial Risk & What Causes Denials
Denial risk: incomplete or missing documentation, off-label standalone device use when FDA approval requires concurrent cataract surgery, or failure to demonstrate prior conservative therapy may result in denial.
If device is FDA-approved only with cataract surgery (e.g., iStent inject, Hydrus) and procedure is billed as standalone, expect off-label review and likely denial without strong supporting clinical rationale.
Missing baseline IOP measurements, medication history, or documentation of prior treatment attempts increases risk of claim denial.
State Medicaid plans may explicitly exclude certain codes; check the member's Medicaid fee schedule before authorization.
When requesting authorization for combined canaloplasty and trabeculotomy (e.g., OMNI, Streamline) with phacoemulsification, provide evidence of candidacy and document that the procedure is intended for mild-to-moderate OAG with expected modest IOP reduction.
Include preoperative washout or baseline diurnal IOP when available, number and type of glaucoma medications, and target IOP.
If device/procedure is relatively new or evidence is limited, include peer-reviewed publications or trial identifiers to support medical necessity.
Documentation Required
Postoperative Documentation
Operational note: retain postoperative follow-up data in the medical record to support continued medical necessity and outcomes tracking where applicable.
Document postoperative IOP, number of glaucoma medications, complications (e.g., hyphema, IOP spikes), and any secondary surgical interventions at routine intervals (e.g., 1, 3, 6, 12 months).
Maintain records of medication changes and objective outcome measures to support claims and any potential continuation reviews.
Glaucoma drainage devices (GDDs) are implants that shunt aqueous humor to create a bleb or divert flow to Schlemm's canal, subconjunctival, or suprachoroidal spaces to lower IOP.
Common examplesEX‑PRESS Mini Glaucoma Shunt, Molteno implant, Baerveldt tube shunt, Ahmed glaucoma valve, Krupin‑Denver valve, XEN Gel Stent.
MechanismsMay bypass trabecular meshwork into Schlemm's canal (e.g., iStent) or route fluid to an external plate/bleb (e.g., Baerveldt, Ahmed, XEN).
DefinitionLaser peripheral iridoplasty (LPIp) uses low‑energy argon laser photocoagulation applied to the peripheral iris to contract tissue away from the trabecular meshwork, widening the anterior chamber angle and potentially lowering IOP, often combined with peripheral iridotomy.
Typical indicationUsed in primary angle‑closure disease to increase angle width; evidence for additional IOP lowering versus iridotomy alone is limited.
Evidence noteSmall RCTs and systematic reviews show increased angle metrics but inconsistent additional IOP benefit; use may be selective when appositional closure persists after iridotomy.
Cyclodestructive procedures (CPC): definition
DefinitionCyclodestructive procedures (e.g., cyclophotocoagulation, CPC) ablate or damage the ciliary body secretory epithelium to reduce aqueous humor production and lower IOP.
Typical useTraditionally reserved for refractory glaucomas where other medical or surgical options have failed or are inappropriate.
Safety/evidence noteSystematic reviews find inconclusive evidence of superiority versus other treatments; common adverse events include hypotony and phthisis bulbi.
DefinitionAb‑interno canaloplasty/viscodilation are minimally invasive procedures that dilate Schlemm's canal via an internal approach (microcatheter cannulation and viscoelastic injection) to improve trabecular outflow.
Devices/examplesPerformed with devices such as VISCO360, OMNI, Streamline, or iTRACK microcannula; may be done alone or combined with cataract surgery.
Outcome/evidence noteCase series and interim RCTs report reductions in IOP and medication use up to 12 months, but comparative effectiveness versus other MIGS remains limited.
OMNI surgical system description
Device descriptionThe OMNI Surgical System is a handheld instrument used to microcatheterize and viscodilate Schlemm's canal (canaloplasty) and to perform trabeculotomy by re‑accessing and incising the trabecular meshwork.
FunctionPerforms sequential ab‑interno canaloplasty (viscodilation of SC and collector channels) followed by trabeculotomy in a single integrated device.
Evidence noteCase series report substantial IOP and medication reductions at 12 months when combined with phaco, but studies lack control groups and have limited follow‑up.
KDB (Kahook Dual Blade): definition
Device/techniqueKahook Dual Blade (KDB) is an excisional goniotomy device used to remove a strip of trabecular meshwork via an ab‑interno approach.
Typical contextOften performed combined with phacoemulsification (phaco‑KDB) to lower IOP and reduce medication burden in mild to moderate OAG.
Evidence noteSystematic reviews and RCTs report greater early IOP and medication reduction versus phaco alone or some stents, with common AEs including hyphema and transient IOP spikes.
Trabectome: definition
Device/techniqueTrabectome is an electrosurgical ab‑interno trabecular ablation platform that uses an electrode tip to ablate trabecular meshwork and improve outflow.
Use contextCan be performed alone or combined with cataract surgery to lower IOP in open‑angle glaucoma.
Evidence noteAvailable evidence is of low quality with limitations (nonrandomized studies); additional RCTs are needed to determine comparative effectiveness.
MIGS approaches: summary
Approach categoriesMIGS approaches target trabecular meshwork/Schlemm's canal, suprachoroidal space, or subconjunctival space and include stent bypass, excisional goniotomy, canaloplasty/viscodilation, and subconjunctival shunts.
Relative efficacy/safetyMIGS generally have lower complication rates but more modest IOP lowering compared with trabeculectomy or aqueous shunts; device‑specific outcomes vary.
Regulatory contextSome devices (e.g., iStent, Hydrus) have FDA approvals that limit use to combination with cataract surgery; standalone use may be off‑label.
GATT: definition
DefinitionGonioscopy‑assisted transluminal trabeculotomy (GATT) is an ab‑interno trabeculotomy using an illuminated microcatheter or suture to perform circumferential (360°) trabeculotomy via the canal of Schlemm.
Clinical findingsCase series report IOP and medication reductions up to 24 months in various OAG types, but evidence is nonrandomized and limited by study design.
Common AEsHyphema is commonly reported; long‑term comparative data are lacking.
Eagle (laser) device identifier
IdentifierEagle device — FDA K‑number: K230722; approved for selective laser trabeculoplasty (SLT).
Intended useA Q‑switched, 532 nm Nd:YAG laser intended for SLT to lower IOP in glaucoma patients.
OPTIMIS FUSION device identifier
IdentifierOPTIMIS FUSION ophthalmic laser systems — FDA K‑number family: K140336; approved for YAG and SLT uses including iridotomy and SLT.
Intended useFamily includes delivery devices approved for procedures such as posterior capsulotomy, iridotomy, and selective laser trabeculoplasty.