Microinvasive subconjunctival insertion of a trans-scleral gelatin stent for primary open-angle glaucoma

2.1 Open-angle glaucoma is a chronic condition associated with increased intraocular pressure, which leads to progressive damage to the optic nerve. Early stages are usually asymptomatic but as the condition progresses it causes visual impairment and, if untreated, blindness.

2.2 Treatment is usually eye drops containing drugs that either reduce the production of aqueous humor or increase its drainage. Surgical procedures such as trabeculectomy, inserting drainage tubes, deep sclerectomy, viscocanalostomy or laser trabeculoplasty may also be used.

2.3 Microinvasive insertion of a trans-scleral gelatin stent via the ab interno approach (placed surgically from the anterior chamber, outwards to the subconjunctival space) for treating open-angle glaucoma is a minimally invasive procedure. It involves implanting a gelatin stent, a collagen-derived drainage device, to reduce intraocular pressure. The collagen is derived from animal sources. The procedure creates an artificial bypass channel and drainage pathway from the anterior chamber into the non-dissected tissue of the subconjunctival space to improve drainage and outflow of aqueous humor.

2.4 This procedure can be done at the same time as phacoemulsification and intraocular lens insertion for treating cataracts.

2.5 Under local or topical anaesthesia, a small incision is made in the cornea, and the anterior chamber is filled with viscoelastic. A preloaded implant injector is then advanced through the same corneal incision and directed towards the scleral spur. The injector needle is directed through the sclera to emerge under the conjunctiva, approximately 2 mm to 3 mm behind the limbus. The soft and permanent gelatin stent is then injected, to traverse the anterior chamber, sclera and conjunctival space. After placement is checked (using a gonioscopy mirror) the viscoelastic is exchanged for a balanced salt solution and the injector is withdrawn. The corneal incision is usually self-sealing but is sometimes sutured. Subconjunctival injection of mitomycin‑C may be done during the procedure.