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The piece frames glaucoma management through intraocular pressure reduction, contrasts MIGSs with traditional trabeculectomy, and summarizes key debate areas: canal-opening surgery mechanisms, long-term outcomes, and tissue responses in animals versus humans. It also highlights comparative findings across device types and canal-opening extents, while noting controversies regarding combined cataract surgery and factors affecting surgical efficiency and positioning.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/clinical-debates-in-minimally-invasive-glaucoma-surgeries-migss-editorial/462507/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/clinical-debates-in-minimally-invasive-glaucoma-surgeries-migss-editorial/462507.png","ImageObject",300,407,{"name":92,"@type":93},"Aditya","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-08","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":14},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why does the editorial emphasize intraocular pressure (IOP) as the main modifiable strategy for glaucoma?","Question",{"text":112,"@type":113},"IOP reduction is described as the only evidence-based and modifiable treatment approach. Medical therapy and lasers are first-line, but surgery is required when they fail to achieve adequate IOP control.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How are minimally invasive glaucoma surgeries (MIGSs) positioned relative to trabeculectomy?",{"text":117,"@type":113},"Trabeculectomy is considered the traditional gold standard but is linked to high postoperative complication risks. MIGSs were developed to address these shortcomings and have improved understanding of safety and efficacy over the past decade.",{"name":119,"@type":110,"acceptedAnswer":120},"What controversies does the editorial highlight for canal-opening surgery (COS)?",{"text":121,"@type":113},"The editorial notes ongoing debate over COS mechanism and clinical outcomes. 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Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \n1 Department of Ophthalmology, Shimane University, Enya 693-8501, Shimane, Japan; [chiha492001@gmail.com](chiha492001@gmail.com); Tel.: +81-774-45-2060  \n2 Sensho-kai Eye Institute, Uji 611-0043, Kyoto, Japan  \nI am pleased to introduce this Special Issue of the Journal of Clinical Medicine, dedicated to “Clinical Debates in minimally Invasive Glaucoma Surgeries (MIGSs)”, which address current and emerging topics in glaucoma surgery.  \nGlaucoma is one of the leading causes of blindness worldwide [1,2] . Reduction in intraocular pressure (IOP) remains the only evidence-based and modifiable treatment strategy for glaucoma. Medical therapy and laser procedures are considered first-line approaches for lowering IOP; however, when these treatments fail to achieve adequate IOP control, surgical intervention becomes necessary.  \nTraditionally, trabeculectomy has been regarded as the gold standard surgical treatment for glaucoma. However, this procedure is associated with a high risk of postoperative complications, including bleb leaks, infection, postoperative hypotony, and deterioration of visual acuity [3,4] .  \nTo address the shortcomings of trabeculectomy, minimally invasive glaucoma surgeries (MIGSs) have been developed. Over the past decade, substantial advances have been made in understanding the mechanism of IOP reduction, as well as the safety profile and surgical efficacy of MIGS procedures. This Special Issue covers a broad spectrum of topics, including the historical evolution of MIGS, recent trends in surgical decision making, advances in surgical devices and technologies, and tissue responses following MIGS procedures.  \nThere are several types of MIGSs, among which canal-opening surgery (COS) is oneof the most widely used subtypes. There has been a long-standing debate regarding the mechanism of action and clinical outcomes of COS. Chihara and Hamanaka (Contribution 1) reviewed the historical development of MIGS and critically discussed the mechanism of action underlying COS. It took considerable time to understand the differences in tissue responses between experimental monkey eyes, where the trabecular opening closes shortly after surgery due to tissue regeneration [5], resulting in limited improvement in outflow facility [6], and human eyes, in which canal opening tends to persist [7] and IOP reduction is maintained over a long period [8] . The long-term debate on the clinical outcome of COSin human eyes is extensively reviewed in a review article of this series (Contribution 1) .  \nThere are several types of MIGS. Among them, canal opening surgeries, which originated from trabeculotomy ab externo, have recently evolved and are now widely used for the treatment of mild to moderate open angle glaucoma (OAG) . With respect to postoperative visual acuity, there is a clear contrast between COS and trabeculectomy. The advantage of MIGS in preserving and restoring visual acuity was elegantly demonstrated by Kasahara et al. (Contribution 2), which is one of the key reasons COS is increasingly selected for patients with mild to moderate OAG.  \nAn increasing trend in the use of MIGS has been reported in several studies [9,10], and this trend was further confirmed by Iwasaki et al. (Contribution 3) in this Special Issue. The extent of canal opening and the type of device used to open Schlemm’s canal may influence surgical outcomes. Sugihara et al. (Contribution 4) reported that IOP reduction after 120-degree canal opening did not differ significantly from that after 240-degree canal opening using the Tanito microhook. This finding is consist","cbCaip9PkNyFTmhE","https://ap.wps.com/l/cbCaip9PkNyFTmhE","pdf",168763,"English","# Editorial\n## MIGSs overview and rationale\n## Trabeculectomy limitations and MIGSs advantages\n## Canal-opening surgery debates and mechanisms\n## Outcomes by canal-opening extent and devices\n## Effects of prior trabeculectomy and combined cataract surgery\n## iStent implantation factors\n## Hydrus Microstent positioning and technical challenges","[{\"question\":\"Why does the editorial emphasize intraocular pressure (IOP) as the main modifiable strategy for glaucoma?\",\"answer\":\"IOP reduction is described as the only evidence-based and modifiable treatment approach. Medical therapy and lasers are first-line, but surgery is required when they fail to achieve adequate IOP control.\"},{\"question\":\"How are minimally invasive glaucoma surgeries (MIGSs) positioned relative to trabeculectomy?\",\"answer\":\"Trabeculectomy is considered the traditional gold standard but is linked to high postoperative complication risks. MIGSs were developed to address these shortcomings and have improved understanding of safety and efficacy over the past decade.\"},{\"question\":\"What controversies does the editorial highlight for canal-opening surgery (COS)?\",\"answer\":\"The editorial notes ongoing debate over COS mechanism and clinical outcomes. It contrasts experimental findings where canal openings may close with tissue regeneration versus human outcomes where canal opening tends to persist and IOP reduction is maintained long-term.\"}]","Clinical Debates in Minimally Invasive Glaucoma Surgeries (MIGSs) - Editorial | PDF"]