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@RetinaRounds sign up for our sister channel RetinaRounds.com When performing gonioscopy on this patient in the clinic, our guest surgeon noted that it was challenging to see the trabecular meshwork (TM). To improve visualization of the TM during MIGS (minimally invasive glaucoma surgery), he uses trypan blue dye to stain the TM. This works very well and really improves visibility. His best pearls for this case are: As shown in the video, I used trypan blue twice, early on before capsulorhexis (under air) and once again after implanting the IOL (under viscoelastic). One need not fill the entire anterior chamber with trypan blue - aiming for the nasal angle suffices. Clear corneal incision should not be on the short side, so as not to allow viscoelastic egress as we enter the eye with the iStent injector in the tilted position. Capsulorhexis should be well-centered and covering the edges of the IOL 360 degrees to prevent IOL dislocation during surgery, especially if a toric IOL is used. When the first iStent is misfired/misplaced, it is important to proceed with the second iStent implantation rather than try to reposition and reinject the first, free-floating iStent, since potential angle bleeding may hinder appropriate placement of the second iStent. As we see in the video, I fiddled with the first iStent until I was able to engage it into the tip of the injector, and a second trial to implant it also failed. A third attempt resulted in successful implantation. It is important to inject viscoelastic in the angle to clearly visualize the correct placement of the iStent. It is more important to be absolutely sure the iStent is inserted and is not freely floating in the eye. After injecting more viscoelastic, I was able to verify the correct placement of both iStents, although they are closer to each other than I would've liked. The patient was able to get off 2 of her glaucoma medications following the procedure.