Surgical Considerations for Implanting Travoprost Intracameral Implant (iDose)

EP: 1.Interventional Approaches to Lower IOP and Minimize Medication Use

EP: 2.Procedural Pharmaceuticals in Glaucoma: Focus on Bimatoprost and Travoprost Implants

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EP: 3.Surgical Considerations for Implanting Travoprost Intracameral Implant (iDose)

In this segment, the panelist demonstrates the surgical placement of the iDose implant, emphasizing its similarity to minimally invasive glaucoma surgery in terms of visualization and technique. Using a gonio prism, the nasal angle is identified, and the implant is inserted through the trabecular meshwork into the scleral wall with a trocar. Once deployed, stabilizing prongs are released, and the device is gently tapped side-to-side to ensure it is securely seated and positioned correctly within the anterior chamber, pointing away from sensitive structures like the iris and cornea. The implant’s stability is highlighted as it remains steady even during irrigation and aspiration.

The panelist then addresses the topic of repositioning, showing how easy it is to adjust the device if it is not fully embedded. In one case, part of the trocar remained exposed in the anterior chamber, indicating suboptimal placement. The device was successfully repositioned by regrasping, retracting the prongs, and reinserting the implant with slightly more pressure. After this adjustment, external and internal views confirmed that the trocar was no longer exposed, and the implant was more securely anchored within the scleral wall. This demonstration reassured that minor placement issues can be corrected efficiently without compromising stability.

Finally, the discussion turns to whether the iDose can be placed after a goniotomy or trabecular meshwork removal. Using a video example, the panelist shows that the implant can still be stably inserted into the scleral wall even when no trabecular meshwork remains. This reinforces that the implant does not depend on the meshwork for fixation, expanding its use in patients who have undergone prior procedures. Overall, the segment underscores the versatility, stability, and ease of repositioning of the iDose implant, making it a practical option in a range of surgical scenarios.