At the American Academy of Ophthalmology (AAO) 2026 meeting in New Orleans, Steven R. Sarkisian, MD, Jacob W. Brubaker, MD, Zarmeena Vendal, MD, Larissa Camejo, MD, and Roma Patel, MD, discussed techniques and considerations for ab interno glaucoma surgery, including minimally invasive glaucoma surgery (MIGS).

This video transcript has been edited for clarity and is located at the end of the article. 

The discussion covered microscope setup and gonioscopic techniques, including trabecular microbypass stenting with iStent (Glaukos) and Hydrus (Alcon); ab interno goniotomy and/or viscodilation with Kahook Dual Blade, Streamline, and Via360 (New World Medical), TrabEx (Microsurgical Technology), the Omni Surgical System and Sion (Sight Sciences), and iTrack Advance (Nova Eye Medical); and supraciliary stenting with AlloFlo Uveo (Iantrek).

Dr. Brubaker noted that the Hydrus MircroStent (Alcon) features a 90° stent that has both windows and an inlet; the iStent Inject W (Glaukos), which is the third iteration of the iStent, features 2 preloaded stents; and the iStent Infinite (Glaukos), the fourth iteration of iStent, features 3 preloaded stents.

He explained that ophthalmologists should mind their angles of approach and to understand their device and how to adjust for a second go if needed.

“MIGS has evolved from a specialized procedure primarily performed by early adopters or glaucoma specialists to a standard practice that every comprehensive ophthalmologist should feel comfortable performing,” he said. “Glaucoma trabecular stents, including iStent and Hydrus, are crucial devices that should be in the toolbox for any cataract surgeon.”

Dr. Vendal said that MIGS is essential in moving the interventional glaucoma needle for glaucoma patients. “We manage glaucoma way more effectively by training all ophthalmic surgeons to treat glaucoma with an interventional mindset rather than limiting that treatment paradigm to just glaucoma specialists.”

Dr. Camejo explained that with so many MIGS options available, the challenge is no longer simply whether to intervene, but when, how, and with which procedure. “Thoughtful MIGS selection allows us to individualize glaucoma care while reducing medication burden, improving the ocular surface, and preserving the opportunity to meet our patients’ refractive goals, visual expectations, and quality-of-life needs,” she said.

Video Transcript

Hi, I'm Steven R. Sarkisian, Jr., MD, founder and CEO of Oklahoma Eye Surgeons in Oklahoma City. At the AAO meeting in New Orleans 2026, we talked about MIGS in the course "MIGS: Devices and Incisional Techniques." I moderated the course and was accompanied by Jacob Brubaker, MD; Larissa Camejo, MD; Roma Patel, MD; and Zarmeena Vendal, MD. And really thinking about MIGS, we categorize it in the different places that aqueous can move. So the canal, the suprachoroidal space, the subconjunctival space, and then aqueous production. Because for a lot of general ophthalmologists, it can be really overwhelming to have to think about MIGS because there's so many different options. So we broke it down, we broke it down into pieces, we kept it simple as long as we could in 75 minutes, and then presented practical cases and examples because really in the end, people don't know what they need or what they want until you show them.

And so we were able to show them opportunities and cases where they can use MIGS in their everyday practices. And the feedback for several years has been very positive about this course because of how practical it is. I was proud to serve the Academy membership by helping provide this course for them and keeping it useful and practical for their practices every day.