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Gokulan Ratnarajan, Andrei-Alexandru Szigiato, Simrenjeet Sandhu, Michael Dorey, Iqbal Ahmad; Surgeon Perspectives and Learning Curve with an Ab-Interno Gelatin Microstent. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4937. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Minimally invasive glaucoma surgery (MIGS) aims to provide a lowering of intraocular pressure with an excellent safety profile. However, there is a lack of data describing the learning process of these techniques and how it compares to other surgeries. In this study, we aim to evaluate and compare an ab interno gelatin microstent (XEN-45, Allergan) to other glaucoma surgeries from the surgeon’s perspective.
A cross-sectional survey study was conducted using a survey instrument developed to measure factors associated with learning and clinical use of the gelatin microstent. The survey was validated using input from 3 experienced glaucoma surgeons. Evaluation criteria included prior surgical experience, patient selection criteria, stepwise analysis of device implantation, post-operative care and incorporating the device into practice. 30 surgeons in Canada who used the gelatin microstent were identified and emailed the anonymous survey instrument (FluidSurveys, Survey Monkey).
Surgeons were in early-mid career (11.8 ±7.2 operating years) and experienced with filtration surgery (94.1% very comfortable). Most surgeons selected patients for implantation on the following criteria: moderate to advanced disease (88.2% and 76.5% of surgeons, respectively), diagnosis of POAG or PXG (70.6%), on 2, 3, or 4 glaucoma medications (70.6%, 75.5%, 70.6%, respectively), and had prior MIGS (70.6%). Creation of the scleral tunnel into the subconjunctival space and stent deployment were rated the most difficult steps of the surgery. Most surgeons (52.9%) required 6-10 cases to be comfortable with the procedure and felt it was easier to gain proficiency with gelatin microstent implantation than filtration surgery (94.1% agree or strongly agree).
A group of experienced glaucoma surgeons used an ab interno gelatin microstent to manage patients with moderate to advanced glaucoma and thought the procedure was easier to learn than traditional filtration surgery. We hope that this data, as well as key learning points shared by surgeons who participated, will be helpful to guide surgeons who are beginning to use this device.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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