iStent insertion and MIGS surgery principles for glaucoma treatment in 4k скачать в хорошем качестве

iStent insertion and MIGS surgery principles for glaucoma treatment in 4k

Dr. Stephen Tate is a cataract and anterior segment surgeon at New Vision Eye Center in Vero Beach, FL. The principles of MIGS surgery procedures are the same with any of the current popular canal based devices including the iStent, iStent inject, hydrus microstent or Visco360 and Visco720. There are 4 basic steps with any of these devices: 1. Patient positioning. Patient chin down for surgeons operating from the head and patient turned away from the surgeon for those operating from a temporal approach. 2. Filling the anterior chamber. The angle is filled with a cohesive OVD until IOP approximates 15 to 20 mmHg. With standard 2.4mm incisions this can be achieved by simply injecting the ovd until it refluxes form the CCI. One tip that I have found useful is to inject the cohesive ovd in a way that displaces any dispersive ovd from the angle of the eye. This makes viscoelastic removal from the angle easier at the end of the case and can help avoid post op IOP spikes. 3. Angle Structure identification. The cornea is coated with OVD and a gonioprism is used to identify the angle structures. This step is critical to avoid placing the device into the ciliary body band or under descemet’s at Schwalbe’s line. 4. Device injection - Once the sclearal spur and ciliary body band have been identified, the device being used is deployed through the trabecular meshwork into schlemm’s canal. The iStent injecting technique used in the cases in this video employs a gentle sweeping technique to catch the delicate and slightly elastic trabecular meshwork on the tip of the stent. Once the tip of the stent is engaged it is usually easily advanced into the canal. In my hands I find it best to avoid trying to aim the stent posteriorly into the canal as this can result in the stent becoming lodged in the posterior wall of Schlemm’s canal. Once the tip of the stent has pierced the trabecular meshwork a gentle lift of the inserter tip centripetally can also help avoid impaling the posterior wall of the canal. Post operatively in our center we give our patients diamox. This along with the previously mentioned cohesive ovd injection technique is very effective at limiting IOP spikes at the 1 day post op visit. Thank you for watching