Intraoperative Optical Coherence Tomography for Ab Interno Trabecular Bypass Glaucoma Surgery

The purpose of this study was to demonstrate a case of a novel surgical technique utilizing intraoperative optical coherence tomography (iOCT) to aid implantation and optimal placement of 2 trabecular bypass minimally invasive glaucoma surgery devices-the iStent inject W and the Hydrus microstent. In iStent inject W implantation, where the depth of stent implantation has been correlated to postoperative outcomes. the iOCT allowed real-time appreciation of device implantation depth relative to the trabecular meshwork surface. In Hydrus microstent implantation, the iOCT allowed confirmation of successful stent placement within the Schlemm canal, and may help in cases where intraoperative gonioscopic view of the 3 microstent windows is impeded. This case demonstrated the use of the iOCT as an imaging adjunct to ensure optimal placement of trabecular bypass minimally invasive glaucoma surgery devices such as the iStent inject W and Hydrus microstent.