In this case the patient has a successful cataract surgery but then during the MIGS procedure, a trabeculotomy is done with the Omni device which causes a lot of bleeding from the angle. Bleeding from the angle is usually a self-limiting complication and if blood reflux occurs intraoperatively, it is helpful to maintain anterior chamber stability with a cohesive viscoelastic to tamponade bleeding and prevent chamber collapse. Avoid excessive irrigation, as this can increase bleeding by washing away the forming clot. At the end of surgery, gently irrigate residual blood while leaving a small amount of viscoelastic to maintain pressure. In most cases angle bleeding resolves without intervention, and vision typically recovers fully within days to weeks. What is your best advice to handle bleeding during MIGS? Please comment below.
