iStent (2nd Generation)

Description of Procedure:

Prior to the date of surgery, the risks, benefits, and alternatives of the planned procedure were discussed with the patient, and informed consent was obtained. The patient was identified in the preoperative area by the attending physician, and the operative eye was marked. The patient was taken to the operative suite and given IV sedation and topical ocular anesthesia. The operative eye was prepped and draped in the usual sterile ophthalmic fashion. A lid speculum was inserted.

A paracentesis was made into clear cornea. Lidocaine and viscoelastic were injected into the anterior chamber. A clear corneal incision was made using a keratome. Viscoelastic was injected onto the cornea. The patient’s head was rotated 35 degrees away from the surgeon, and the operating microscope was rotated 35 degrees toward the surgeon. A direct gonioprism was used to visualize the nasal angle. The trabecular meshwork was easily identified. Two iStent injects were injected into the trabecular meshwork approximately two clock hours apart and noted to be secure in good position.

The patient’s head and the operating microscope were rotated back into neutral positions. All remaining viscoelastic was irrigated using balanced salt solution. The corneal incisions were hydrated with balanced salt solution then inspected with a Weck-cel sponge and found to be watertight with good intraocular pressure by finger tension. The speculum and drapes were removed, and antibiotic-steroid drops were placed into the eye. The patient was then transported to the postoperative care unit in good condition.