Stepwise Introduction of Residents to Insertion of Trabecular Micro-Bypass Stents
Purpose
The introduction of minimally invasive glaucoma surgery and recent increased use of trabecular microbypass stents has created a need for residents to become properly trained to use such devices. We describe our technique for instructing residents on the insertion of iStent®.
Methods
At our institution, a stepwise method to teach iStent® insertion is used. Each step is repeated until performed correctly. After mastery is achieved, the resident graduates to the next step. Step 1: Following positioning, the resident learns the intraoperative, direct gonioscopic view using a gonioprism. Step 2: Angle structures must be identified and visualized while rotating the gonioprism. Step 3: Viscoelastic cannula is used to approach the angle and mimic insertion without touching the trabecular meshwork. Step 4: Residents are observed making contact with the angle using the cannula. Step 5: The iStent® is inserted as recommended by Glaukos.
Results
To date, fourteen residents have been instructed using this method and each has successfully completed iStent® insertion as the primary surgeon.
Conclusion
Introducing iStent® insertion in a stepwise manner has prepared residents for insertion as the primary surgeon in a controlled environment. We believe this method is safe and effective and can be used by other programs to teach new minimally invasive glaucoma procedures, which are gaining popularity in the field.