MAY 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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42 EW FEATURE February challenges/MIGS May 2013 Glaucoma 2011 Secrets of success to beginning with the iStent by Maxine Lipner EyeWorld Senior Contributing Writer Fresh pearls from new users S ince its launch in August 2012, the iStent (Glaukos, Laguna Hills, Calif.) has been rapidly adding new users to the fold. Like Understanding the anatomy of the anterior chamber is one of the keys for practitioners new to using the iStent. Source: Chris M. Calcaterra everything else, the first few tries with this device, slated for implantation in mild to moderate glaucoma patients who are undergoing cataract surgery, may seem daunting to a novice. New users should rest assured that they are not alone. EyeWorld gathered some fresh pearls from those with real affinity to the iStent novice since they themselves have only recently adopted the device. One new user, Reay H. Brown, MD, in private practice, Atlanta, recommended building a close relationship with your local Glaukos representative. "They have a huge commitment to helping the early users get started and be successful," Dr. Brown said. Also, he stressed the importance of thoroughly acclimating yourself with the educational materials supplied by the company. There are five key steps for new users, according to Chris M. Calcaterra, chief commercial officer, Glaukos. These include understanding the anatomy of the anterior chamber, knowing how to achieve optimal visualization, understanding the iStent itself, learning about the implantation technique, and becoming knowledgeable about all of the surgical and procedural checks. Optimizing visualization Of these five steps, Mr. Calcaterra views knowing how to achieve optimal visualization as the most important for new users. "Achieving good visualization of the anterior chamber angle is essential for successful implantation of the iStent device," he said. "The more clearly you are able to identify the anatomical landmarks, the more straightforward the procedure will be to perform." Before ever implanting an iStent, Mr. Calcaterra recommended first visiting the www.gonioscopy.org website developed by Wallace Alward, MD, director, glaucoma services, University of Iowa, Iowa City. "It's an excellent website that is dedicated to teaching gonioscopy and angle anatomy," Mr. Calcaterra said. He also urged prospective users to do a few dry runs on routine cataract patients prior to implanting the iStent. "Prior to your first iStent cases, practice intraoperative gonioscopy after completing the cataract procedure," Mr. Calcaterra said. "Adjust the patient's head and the microscope, and then practice placing the gonioprism on the cornea with the non-dominant hand. Use a Sinskey hook or the viscoelastic cannula to approach the angle and mimic the subtle wrist pronation needed for implantation." Dr. Brown likewise recommended doing a "dress rehearsal" at the end of a normal cataract operation. "It would just take a few minutes, and it would give you some practice," he said. He also suggested doing several early cases sequentially. "It helps to schedule two or three cases at a time so that you can build up a series," Dr. Brown said. "It's easier to make improvements when you're doing cases in a row—you build on success."

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