*3.5.1 Definition*

OMNI™ Surgical System is an ab-interno MIGS that combines two functions into one device: microcatherization and vascodilation in up to 360° of the SC (open distal outflow pathway) and cutting of the TM (controlled and Customizable trabeculotomy that removes the resistance of the TM) using a single fully integrated handheld system [11]. The system has got a luer fitting that allows for efficient priming of the device with viscoelastic, a priming lock, a reservoir where microcatheter is retracted, the gears whose movilization with the finger facilitate

**31**

*Cataract Surgery Combined with Trabecular MIGS (Minimally Invasive Glaucoma Surgery)*

microcatheter deployment and retraction, a cannula with a beleved tip that allows for precise acces to target tissues, viscoelastic fluid and a blue microcatheter.

As other MIGS techniques, OMNI can be used isolated or easily in conjunction with cataract surgery, in mild or moderated POAG that do not require a big IOPlowering effect, with a minimal invasive approach and avoiding bleb complications

The head of the patient and the microscope are tilted 30–40° and OMNI is introduced using the temporal clear corneal incision of the cataract surgery towards the nasal angle [11]. A small (<1 mm) goniotomy is created with the cannula tip in order to introduce the microcatheter for 180° of the SC under gonioscopic visualization (**Figure 2(D)**) [11]. Viscoelastic is delivered for viscodilation while microcatheter is retracted [11]. Microcatheter is again advanced and withdrawn with a 90° traction causing the unroof the SC (trabeculotomy) [11]. The process is repeated for the second 180° [10]. This technique allows varying the intensity of the treatment: for example, we can perform a 360° viscodylation and a 180° trabeculotomy.

Adverse events are generally mild, nonseriuous and transient and include anterior chamber inflammation, posterior capsular opaciticity, IOP > 10 mmHg above baseline more than 30 days postoperatively, cystoid macular edema, corneal edema

Some techniques perform a more aggressive treatment than others. It is logical to think that the less aggressive techniques will be used in eyes with glaucoma where the involvement of the TM is smaller, and that, on the contrary, the more aggressive techniques, such as the trabeculotomy with viscodilatation, will be used in cases

If we review the literature in order to compare the different surgical techniques [12–21], we see that, except in some surgical techniques, in the most of the techniques, most of the studies present biases: they are not randomized, they are not prospective, they are simple series, they do not have washout, they use personal criteria, they do not record complications … therefore, we can affirm that the scientific evidence for MIGS surgery in comparison with other techniques is very limited, although it has been demonstrated a decrease in IOP, a decrease in the number of

If we focus on surgical success, understanding it such as a IOP reduction greater than 20%, most techniques reach a rate success of 60–80% (**Table 1**). Evidence A and B can only be found with the iStent, the Hydrus and the trabectome, while in

If we focus on the IOP that these surgical techniques achieve, we see that in the most of the cases the IOP reached is between 15 and 17 mmHg (**Table 2**), a limita-

where the involvement of the TM is much more intense.

OMNI and Kahook the grade of recommendation is C (**Table 1**).

tion that is given by the episcleral venous pressure.

drugs and a decrease in complications.

and without conditioning future conjunctival bleb surgeries [11].

*DOI: http://dx.doi.org/10.5772/intechopen.95416*

*3.5.2 Indications and contraindications*

*3.5.3 Surgical technique*

*3.5.4 Security*

and hyphema [11].

**4. Scientific evidence**

microcatheter deployment and retraction, a cannula with a beleved tip that allows for precise acces to target tissues, viscoelastic fluid and a blue microcatheter.
