Launched in the United States in March 2019 after receiving FDA approval the prior year, the
OMNI Surgical System (Sight Sciences, Inc) could be considered a technological leap for
microinvasive glaucoma surgery (MIGS) procedures by offering surgeons the ability to perform ab interno canaloplasty followed by trabeculotomy using a single device.
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What does the OMNI Ergo-Series offer surgeons?
One of the significant challenges faced in primary open-angle glaucoma (POAG) cases is pinpointing the spot or area of resistance and identifying blockages within the conventional outflow pathway in order to renew the aqueous humor outflow to the degree needed to lower intraocular pressure (IOP).
OMNI addressed this by targeting not only the trabecular meshwork (TM) with an
ab interno transluminal trabeculotomy but also the Schlemm’s canal and collector channels using an implant-free approach with a microcatheter and viscoelastic fluid.
As effective as the
original OMNI Surgical System was, the company saw room for refinement and enhanced several features on the device, resulting in the new Ergo-Series.
In this segment of Interventional Mindset, Nathan Radcliffe, MD, shares two surgical videos in which he used the OMNI Ergo-Series and revealed the key features of the new design that he found most valuable.
Key features of the Ergo-Series
Three primary improvements were made to OMNI, including optimized ergonomics to the handle, a new tip design, and a simplified process for viscodilation preparation.
- The newly designed handle enables surgeons to position the cannula tip within the Schlemm’s canal by using finger rotations as opposed to wrist adjustment, leading to improved accuracy in placement.
- The cannula tip contains a new profile that enables easier access and entrance to Schlemm’s canal while still allowing full 360° catheterization.
- In the new instrument, to give more clearance with the surgical microscope, the viscoelastic luer connector detaches and is removable once the viscoelastic cartridge has been removed.
Advantages of the Ergo-Series from the surgeon’s perspective
Having extensively used both the original OMNI and the latest generation Ergo-Series, Dr. Radcliffe holds a first-hand perspective on how these innovations can elevate surgical techniques. He considers the tapered tip the game changer, as it permits the surgeon to pierce the canal with more facility to perform
goniotomy, which in turn can lead to a clearer path for the catheter.
Dr. Radcliffe also noted the wheel is better refined, allowing for an easier entry point into Schlemm’s canal. Additionally, he stated the handle offers better tactile input with the flexi-grip surface along with better overall maneuverability for a smooth deployment and retraction of the catheter—which are key factors when thinking about improving visualization.
He pointed out that with more challenging cases, time is of the essence, and being able to move quickly to complete the surgery is critical for potentially
achieving optimal results.
In the second surgical video within this session, he demonstrates an instance where the chamber did not remain formed, and there was blood flow from the side port incisions; however, the Ergo’s agility allowed him to proceed expeditiously to complete the procedure.
Surgical pearls for using the OMNI Ergo-Series
Dr. Radcliffe offered this closing advice as the key to avoiding blood reflux after using OMNI Ergo-Series:
- Keep the eye pressurized even in the last moments of the case.
- Pay close attention to maintaining good hydration.
- Ensure the eye remains relatively firm at the end.
- Placing an intravitreal injection of triamcinolone/moxifloxacin can also help to allow the eye to remain firm.
In closing
Companies might consider adopting this philosophy by introducing instruments that could disrupt progression earlier in the disease process by refining current technologies to simplify surgical procedures to possibly enhance outcomes.
Disclaimer: The Ergo-Series is the second generation of the OMNI Surgical System (Sight Sciences, Inc) which is indicated for canaloplasty (microcatheterization and transluminal viscodilation of Schlemm’s canal) followed by trabeculotomy (cutting of trabecular meshwork) to reduce intraocular pressure in adult patients with primary open-angle glaucoma. The medical opinions and views expressed in this article are those of Nathan Radcliffe, MD.
