The rise of nontuberculous mycobacteria following MIGS and minimally invasive procedures

Nontuberculous mycobacteria (NTM) infections are emerging as a significant complication following minimally invasive glaucoma surgeries (MIGS) and other low-trauma procedures. These environmental pathogens, including Mycobacterium abscessus, M. chelonae , and M. fortuitum , are increasingly implicated in delayed-onset postoperative infections, often resistant to standard antibiotics and disinfection protocols. Recent reports suggest that NTM may account for up to 2.5% of post-MIGS infections, with molecular diagnostics identifying NTM in 18% of unexplained postoperative inflammation cases. These infections frequently present as low-grade inflammation or device-associated biofilm formation, complicating diagnosis and management. Continued reliance on conventional sterilization and prophylaxis risks persistent infection, delayed treatment, and increased morbidity. We argue that perioperative protocols should incorporate routine NTM screening, enhanced sterilization for fluid-based surgical systems, and risk-stratified surveillance. Strengthening awareness and reporting of NTM infections is essential to preserving the safety of minimally invasive procedures and improving surgical outcomes.