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    MICS & MIGS: combined surgery with microstent devices

     

    MIGS with microstents

    Over recent years, new microstent devices for ab interno MIGS have been developed.

    Aimed at the subconjunctival space is the XEN Gel Stent (AqueSys). Other implants – including the Hydrus Microstent (Ivantis) and the first- and second-generation iStent Trabecular Micro-Bypass Stents (Glaukos) – target the Schlemm canal, while the third-generation iStent and the CyPass microstent (Transcend Medical) are aimed at the suprachoroidal space.

    Personal experience

    Figure 1Of the devices listed above, the microstents with which we have the most experience are the iStent Trabecular Micro-Bypass Stent (Glaukos, Laguna Hills, CA) (Figure 1) and the XEN Gel Stent (Aquesys Inc.) (Figure 2).Figure 2

    The iStent Trabecular Micro-Bypass Stent received FDA approval in 2012. This is the smallest FDA-approved device, measuring 0.3 mm in height and 1 mm in length, and is a heparin-coated non-ferromagnetic titanium stent with a snorkel shape to facilitate implantation. The device is placed using a sterile single-use inserter through a 1.5 mm corneal incision. The applicator is inserted into the anterior chamber and across the nasal angle, while the angle is carefully visualised with a goniolens. The pointed tip allows penetration of the trabecular meshwork and insertion into Schlemm’s canal, and three retention arches ensure that the device will be held in place. In our department, 23 eyes were implanted with this device. iStent implantation with phacoemulsification resulted in a significantly lower long-term decrease in IOP and the number of medications used compared with phacoemulsification alone. No major complications were found in our series.

    Dr Antonio Toso

    Dr Antonio Toso is the director of the Vitreo?Retinal Surgery Unit in the Ophthalmic Department of the St Bassiano Hospital in ...

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