Implantation of two trabecular micro-bypass stents for POAG
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
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
- Swan Jacob gonioprism with Berdahl gonioprism stabilizer
- Healon GV (Abbott)
- iStent trabecular micro-bypass stent (Glaukos Corp.)
- 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.
- Swan Jacob gonioprism placed on surface of cornea with non-dominant hand while pre-loaded stent injector device is inserted through main incision.
- 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.
- Note: More pigmented regions of the trabecular meshwork are targeted if visualized that may suggest presence of collector channels.
- 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.
- 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.
- Once both stents are securely placed, the remaining viscoelastic in the anterior chamber is washed out using irrigation and aspiration.
- Patients are kept on their preoperative glaucoma drop regimen until the one week postoperative visit.
- 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/