This article was originally published in a sponsored newsletter.
The FDA-cleared iStent infinite (Glaukos) as a standalone option, independent from cataract surgery, has opened a door for us to help more patients. It has also improved thanks to the unlimited clicks for positioning. Since implementing the device into my practice, I have learned a few things about surgical technique.
First and foremost, I love the new design. It allows you to focus on placing one stent correctly before moving on to the next one. Even if a stent misfires, you do not have to worry about two stents being on the cannula at the same time. The next one won’t load until you’re ready. This development has helped implantation tremendously because it ensures the first stent is done correctly before moving on.
I’ve also learned the best way to hold the device. As a right-handed surgeon, I initially found that it was easiest to place the first stent and the second stent 2 clock hours to the left. However, when I went to the right with the third stent, I had a more limited range of motion. Therefore, I placed my first and second stents, came out of the eye completely, rotated the microscope approximately 20°, and went back into the eye to place the third stent. I found this approach decreased the risk of mis-implantation and allowed me to get proper spacing between the stents instead of accidentally putting them too close together. Good spacing provides access to more collector channels and can have a greater IOP-lowering effect.
In many ways, the introduction of iStent infinite has been a game-changer, both as a standalone option or in conjunction with cataract surgery. As new devices are introduced, it’s beneficial to embrace them and provide more options for our patients.
