Moran CORE

Open source ophthalmology education for students, residents, fellows, healthcare workers, and clinicians. Produced by the Moran Eye Center in partnership with the Eccles Library

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Recurrent Orbital Hemangiopericytoma: Off Label Uses of Trabecular Micro-bypass Stent in Glaucoma

Home / Glaucoma / Surgical Therapy for Glaucoma

Title: Off Label Uses of Trabecular Micro-bypass Stent in Glaucoma
Author: Tanner Ferguson, MSIV, University of South Dakota, USD Sanford School of Medicine
Date: 7/26/2017
Keywords/Main Subjects: Glaucoma; istent; micro-bypass; off label;
Diagnosis: N/A
Brief Description: Present 3-off label uses of the istent trabecular micro-bypass stent in glaucoma patients. 
Format: .mp4
Series: Moran Eye Center Resident Lectures
Identifier: Moran_CORE_24453
Copyright statement: Copyright 2017. Please see terms of use page for more information.


Supraciliary Microstent Implantation

Home / Glaucoma / Surgical Therapy for Glaucoma

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
Date: 09/24/17
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

Surgical Technique

  1. Two clear corneal incisions are created; one superiorly and one temporally, approx. 90 degrees from superior paracentesis.
  2. OVD is instilled through superior incision to stabilize and maintain anterior chamber.
  3. OVD is injected onto surface of cornea as coupling medium between the cornea and lens.
  4. 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.
  5. The gonioprism is placed on the surface of the cornea with the non-dominant hand.
  6. The guidewire is inserted through the primary temporal incision with the dominant hand.
  7. After the anterior chamber angle anatomy is identified, the surgeon aims for the scleral spur landmark.
  8. The guidewire is inserted directly below (posterior) the scleral spur and the micro-stent stent is inserted into the supraciliary space.
    1. 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.
  9. 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.
  10. The residual viscoelastic in the anterior chamber is removed with irrigation/aspiration.

Drops

Visits

Format: Video
Faculty Approval by: Craig Chaya, MD
Identifier: Moran_CORE_24341
Copyright statement: Ferguson ©2017. For further information regarding the rights to this collection, please visit: http://morancore.utah.edu/terms-of-use/

 


Implantation of two trabecular micro-bypass stents for POAG

Home / Glaucoma / Surgical Therapy for Glaucoma

Title: Implantation of two trabecular micro-bypass stents for POAG
Author (s): Tanner Ferguson, MSIV, University of South Dakota School of Medicine, Craig Chaya, MD, Moran Eye Center, University of Utah
Date: 09/24/17
Keywords/Main Subjects: MIGS (minimally invasive glaucoma surgery); glaucoma surgery; glaucoma
Diagnosis: POAG; Glaucoma
Description of Case: This video demonstrates the implantation of 2 trabecular microbypass stents prior to phacoemulsification by Craig Chaya, MD at the Moran Eye Center. Below is our surgical technique for implantation of the 2 stents and standard postoperative regimen.

Note: This video features a repositioning of the second stent. After initial insertion, the stent was not securely placed and the surgeon removed and repositioned the stent.

Note: This video is best viewed in high resolution (720p).

Summary of the Case:
Notable Surgical Instruments

Surgical Protocol

  1. Two clear corneal incisions are created; one superiorly and one temporally, approx. 90 degrees from superior paracentesis.
  2. OVD is instilled through superior incision to stabilize and maintain anterior chamber.
  3. OVD is injected onto surface of cornea as coupling medium between the cornea and lens.
  4. 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.
  5. Swan Jacob gonioprism placed on surface of cornea with non-dominant hand while pre-loaded stent injector device is inserted through main incision.
  6. After angle anatomy is identified and the trabecular meshwork is visualized, the first stent (on tip of inserting device) is guided at approx. the 2 o’clock position at 20-degree angle into the posterior portion of the trabecular meshwork.
    1. Note: More pigmented regions of the trabecular meshwork are targeted if visualized that may suggest presence of collector channels.
  7. Once the stent is released, the inserting device is used to tap or nudge the heel of the stent to ensure it is securely placed.
  8. Steps 6-7 are repeated for the second stent and the second stent is typically inserted 3-4 clock hours away from the first stent.
  9. Once both stents are securely placed, the remaining viscoelastic in the anterior chamber is washed out using irrigation and aspiration.

Postoperative Guidelines

Drops

Visits

Format: Video
Faculty Approval by: Craig Chaya, MD
Identifier: Moran_CORE_24336
Copyright statement: Ferguson ©2017. For further information regarding the rights to this collection, please visit: http://morancore.utah.edu/terms-of-use/