Developing and expanding an interventional mindset requires stepping out of your comfort zone to master new technologies, hone existing skills, and learn new procedures. As a physician who specializes in
cataract and refractive surgery, Gary Wörtz, MD, decided to take on the challenge of adopting microinvasive glaucoma surgery (MIGS), starting with the
Hydrus Microstent (Alcon).
Interventional Mindset is an educational series that gives eye physicians the needed knowledge, edge, and confidence in mastering new technology to grow their practices and provide the highest level of patient care. Our focus is to reduce frustrations associated with adopting new technology by building confidence in your skills to drive transformation.
Browse through our videos on a variety of topics within cataract and refractive surgery, glaucoma, and ocular surface disease to learn practical insights into adopting a variety of new surgical techniques and technology.
Overview of the Hydrus Microstent
Garnering FDA approval in 2018 for the reduction of intraocular pressure (IOP) in individuals with mild to moderate primary open-angle glaucoma, Hydrus is indicated for use
in conjunction with cataract surgery.
The Hydrus Microstent can reconnect the pathway of aqueous from the anterior chamber by bypassing the trabecular meshwork (TM) and directing the flow through the microstent’s inlet leading into the Schlemm’s canal. The device, whose design allows it to dilate and scaffold the canal, is constructed of nitinol, which is both biocompatible and very flexible, allowing for smooth implantation.
Initially, Dr. Wörtz was moderately concerned about the learning curve of the procedure and exactly how difficult the stent might be to implant. However, after a few cases, he became quite comfortable with the procedure and, in the spirit of
Interventional Mindset, was eager to share his technique, offering a few pearls he gleaned along the way.
Pearls for Hydrus Microstent implantation
According to Dr. Wörtz:
- Use the inserter to mimic where the Hydrus is going to be located within the anatomical landmarks from 7 o’clock to 4 o’clock. In order to reach the 4 o’clock mark, make your paracentesis parallel to your phaco incision.
- Turn the head of the patient, tilt the scope to achieve proper alignment, and then dock the tip of the Hydrus into the trabecular meshwork. It will be visible when it enters the TM.
- Feed the microstent into the TM while making certain to angle up slightly.
- Ensure you can see the windows go all the way through.
- Once aligned and in position, release the Hydrus Microstent.
- Close the injector tip and push the microstent further in until you’ve achieved satisfactory visualization.
In conclusion
When performed on patients with good anatomy,
implanting the Hydrus Microstent can be a straightforward procedure that takes approximately 45 seconds and, with patience and practice, allows for consistent results with a favorable complication profile after implantation.
For new surgeons just getting started with Hydrus, Dr. Wörtz hopes that sharing his experience makes their journey a bit easier and serves as encouragement to step up and meet the challenges of adopting the new technologies and techniques that might improve patient outcomes and boost satisfaction.
Disclaimer: Hydrus Microstent from Alcon is indicated for use in conjunction with cataract surgery for the reduction of IOP in adult patients with mild to moderate primary open-angle glaucoma (POAG). The medical opinions and views expressed in this article are those of Gary Wörtz, MD.
