I travel a lot to give lectures internationally at many ophthalmic meetings, averaging about 20 countries per year. When I was in Australia I heard a presentation by Dr Nick Andrew which really had some great pearls for implanting the Hydrus glaucoma stent. I’ve asked him to submit the video so that I can share it with our CataractCoach viewers.
Implanting the Hydrus® Microstent at the time of cataract surgery offers a minimally invasive way to enhance aqueous outflow and lower intraocular pressure in patients with mild to moderate primary open-angle glaucoma. After completing standard phacoemulsification and intraocular lens implantation, attention shifts to the nasal angle, where the Hydrus stent is placed into Schlemm’s canal under gonioscopic guidance.
The anterior chamber is first reformed and deepened with a cohesive ophthalmic viscosurgical device (OVD) to provide optimal visualization of the angle structures. The patient’s head is rotated approximately 30–40 degrees away from the surgeon, and the microscope is tilted toward the surgeon to allow a clear view of the nasal trabecular meshwork through a gonioprism.
The preloaded Hydrus delivery system is introduced through the main corneal incision. The tip is aligned with Schlemm’s canal and gently advanced, threading approximately 90 degrees (three clock hours) of the canal with the stent. The stent’s open scaffold design supports the canal while bypassing the trabecular meshwork, facilitating multidirectional aqueous outflow. After confirming correct placement and stent patency, the delivery system is withdrawn and OVD is thoroughly irrigated from the anterior chamber.
