A procedure using the CyPass micro-stent, which is the only MIGS device to leverage the supraciliary space, was described as minimally invasive and easy to learn during the American Society of Cataract and Refractive Surgery’s 2018 annual meeting in Washington, DC. Best practices covered by Michael Greenwood, MD, a surgeon at Vance Thompson Vision in North Dakota, include the following:
- Visualize the angle. Constrict the pupil using a miotic agent; tilt the microscope 35 to 45 degrees, while tilting the patient’s head 10 degrees in the opposite direction.
- Load the device. Make sure the guidewire tool is inside the loader. Press the rear button on the applier to extend the guidewire into the micro-stent.
- Prepare the anterior chamber. Find the scleral spur using gonioscopy; assess the best location for the implant. Fill the anterior chamber with viscoelastic.
- Enter the space. Insert the applier across the anterior chamber. Rotate the guidewire parallel with the iris plane, then back; the micro-stent and sclera should be aligned.
- Place the device. Advance the guidewire until the most proximal retention ring and collar of the micro-stent appear in the anterior chamber. Press the front button and the guidewire will retract.
- Remove the viscoelastic using an irrigation/aspiration tip.
- Check the incision to make sure it is watertight.
Greenwood M. MIGS part A. Talk presented at: 2018 ASCRS-ASOA Annual Meeting; April 13-17, 2018; Washington, DC.
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