Supraciliary Microstent Implantation
Title: Supraciliary Microstent Implantation
Author (s): Tanner Ferguson, MSIV, University of South Dakota School of Medicine, Craig Chaya, MD, Moran Eye Center, University of Utah
Keywords/Main Subjects: MIGS (minimally invasive glaucoma surgery), glaucoma surgery, glaucoma
Diagnosis: POAG; Glaucoma
Description of Case: This video demonstrates the implantation of a CyPass microstent as a sole procedure by Craig Chaya, MD from the Moran Eye Center, University of Utah. Below is our surgical technique for implantation of the CyPass micro-stent and standard postoperative regimen.
Note: This video is best viewed in high resolution (720p).
Summary of the Case:
Notable Surgical Instruments
- Swan Jacob gonioprism with Berdahl gonioprism stabilizer
- Healon GV (Abbott)
- CyPass Micro-Stent (Alcon, Fort Worth, TX, USA)
- Two clear corneal incisions are created; one superiorly and one temporally, approx. 90 degrees from superior paracentesis.
- OVD is instilled through superior incision to stabilize and maintain anterior chamber.
- OVD is injected onto surface of cornea as coupling medium between the cornea and lens.
- The patient’s head is tilted approximately 30 degrees away from the surgeon and the patient is instructed to look opposite the surgeon. The microscope is adjusted to a comfortable position.
- The gonioprism is placed on the surface of the cornea with the non-dominant hand.
- The guidewire is inserted through the primary temporal incision with the dominant hand.
- After the anterior chamber angle anatomy is identified, the surgeon aims for the scleral spur landmark.
- The guidewire is inserted directly below (posterior) the scleral spur and the micro-stent stent is inserted into the supraciliary space.
- Note: The microstent should guide through the space with minimal resistance. If the surgeon encounters resistance, the surgeon should consider adjustment or an alternative location.
- After the microstent is inserted, the surgeon taps on the proximal edge with the inserting device to secure placement and the retention rings on the device should be visible.
- The residual viscoelastic in the anterior chamber is removed with irrigation/aspiration.
- Patients are instructed to hold their glaucoma medications after surgery because of low pressures commonly encountered in our practice on POD#1.
- Postoperatively, patients were prescribed antibiotics for 1 week, nonsteroidal anti-inflammatory drugs for 4 weeks, and steroid drops for 4 weeks.
- Recheck at PO 1 day, PO 1 week and PO 1 month.
- Reevaluate intraocular pressure 3 months after surgery to assess need for further treatment.
Faculty Approval by: Craig Chaya, MD
Copyright statement: Ferguson ©2017. For further information regarding the rights to this collection, please visit: http://morancore.utah.edu/terms-of-use/