Clinical Pearls: Implanting the Hydrus Microstent

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In this installment of Interventional Mindset, Dr. Wörtz discusses his clinical pearls for implanting the Hydrus Microstent.

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:
  1. 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.
  2. 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.
  3. Feed the microstent into the TM while making certain to angle up slightly.
  4. Ensure you can see the windows go all the way through.
  5. Once aligned and in position, release the Hydrus Microstent.
  6. 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.

Gary Wörtz, MD
About Gary Wörtz, MD

Gary Wörtz, MD is a board-certified ophthalmologist from Lexington, KY specializing in cataract and refractive surgery.

Since completing his training in 2008, Dr. Wörtz has successfully performed thousands of cataract and laser procedures. He currently practices in Lexington at Commonwealth Eye Surgery. Dr. Wörtz became one of the first surgeons in Kentucky to perform laser refractive cataract surgery. He utilizes the latest technology both in and out of the operating room to help restore vision for cataract patients.

Dr. Wörtz enjoys innovation and teaching his techniques to others around the country. He has been a consulting speaker for Alcon, AMO, Bio-Tissue, TearLab, Carl Zeiss Meditech and Dialogue Medical. He has also been a principal investigator in multiple FDA pharmaceutical trials in the ophthalmic sector. He has given numerous lectures at both the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgeons annual meetings. He is also a frequent contributor to many trade journals such Cataract and Refractive Surgery Today, MillennialEye, Ophthalmology Times, and EyeWorld, and was recently named to the editorial board of Ocular Surgery News.

Gary Wörtz, MD
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