Eyeworld Daily News

18 | EYEWORLD DAILY NEWS | MAY 18, 2020 DAILY NEWS ASCRS VIRTUAL ANNUAL MEETING chamber and allows you to rotate the eye a bit). 2. Know your anatomy. A long, rigid misaligned stent can be trouble, he said. 3. Engage the canal at an up- wards angle, then flatten out as the stent is deployed. This helps prevent posterior dives. Dr. Shah concluded by stressing that the "view is key," adding that it's important to take the time to get a perfect gonioscopic view. Don't linger in the angle. He also added that all of these microstents have great versatility and can become straightforward and predictable with practice. These and other presenta- tions can be found in SYM-7. Editors' note: Dr. Butler has finan- cial interests with Aerie, Allergan, Bausch + Lomb, Glaukos, Ivan- tis, and Santen. Dr. Panarelli has financial interests with Allergan, Aerie, Santen, New World Medical, and Glaukos. Dr. Shah has financial interests with Allergan, Katena, and Glaukos. Dr. Kornmann has no related financial interests. He moved on to present on the XEN no-injector technique, which he said offers less peritu- bular flow and more ergonomic hand positioning. Dr. Panarelli offered several final pearls in his presentation: • Open the conjunctiva for adequate exposure. • 2 clock-hour peritomy • Superior sub-Tenon's pock- et slightly nasal/temporal to avoid superior rectus insertion • Mark the bent 27-gauge nee- dle with a marking pen. • Make the scleral entry slight- ly further away from the relaxing incision. • Pull Tenon's up and over the XEN without kinking the stent. Manjool Shah, MD, Ann Arbor, Michigan, focused his presentation on stenting the trabecular meshwork. He noted that there are numerous trabecular microbypass stents available to surgeons. While basic principles apply to all, each has its own nuances and challenges. Dr. Shah first highlighted the iStent (Glaukos), noting that targeted placement may improve results by getting stents closer to larger outflow collector channels. He also mentioned the iStent inject, which he said has the low- est profile of MIGS choices. Axial stent deployment has simplified the insertion pro- cess. However, some of the challenges with iStent inject may include underdeploy- ment, overdeployment, or trocar bias. In terms of trocar bias, he presented that this is often the root cause to a stent misfire. He said to take the time to view the guidewire in the cannula's fenestration. After contacting the trabecular meshwork, eyes should be on this region, he said, not the tip. Meanwhile, iStent inject over- deployment is usually caused by over-dimpling of the cannu- la, and it can be repositioned with micro forceps. Finally, he added the underdeployment is anecdotally more often seen with the second stent, and you will often have two more chances to get it right. Dr. Shah moved on to discuss the Hydrus Microstent (Ivantis), which he said is the largest of the Schlemm's canal microstents at 8-mm long. It's designed to cover 3-clock hours, and when it goes well, it can be very efficient. Dr. Shah noted that challenges arise when it goes either too deep or too superficial. With regard to the Hydrus going too deep, Dr. Shah said to ensure a 15-degree upward angle on the cannula when initiating stent entry and make sure that your view of the tra- becular meshwork is en face, not top down. Meanwhile, considerations to make sure it's not too su- perficial include keeping some pressure on the outer wall during implantation (but don't be too firm). Canal strictures can cause the stent to pop out of the canal, Dr. Shah added, so choose a different site. Dr. Shah offered several Hydrus pearls: 1. Use a separate incision. He suggested 4 clock hours away from the intended entry and a small paracentesis (this helps you maintain the continued from page 16 All live sessions will be made available on the platform for on-demand viewing by May 26, with many sessions available within 24 hour of the meeting. In addition, please enjoy the extensive selection of on-demand papers, skills videos, films, and posters available for viewing at your convenience. Missed a session?

• Cover