Viscoelastic Delamination Suprachoroidal Cleft Technique For Miniject© Minimally Invasive Glaucoma Device System: A New Way To Approach Supraciliary Space

To evaluate the safety and effectiveness of a novel surgical technique approach create the suprachoroidal cleft through viscoelastic in patients undergoing MINIject^© glaucoma device implant, with or without cataract surgery. The focus of the review being a comparison with the current company instruction of implantation provided, especially regarding the safeness and the quality of the view during the procedure, associated with an evaluation of early post operative complications and eye pressure achieved.

Retrospective randomized (1:1), record review of patients who had MINIject^© glaucoma device implantation, stand alone or combined with cataract surgery, in Broomfield hospital (Mid and South Essex NHS trust, UK) between July 2023 and January 2024. Patients were divided in two different group: Group A where suprachoroidal cleft viscoelastic delamination was performed, and a second group (Group B) where MINIject^© was inserted straight forward into supraciliary space. 

Suprachoroidal cleft bleeding during implantation was recorded when the haemorrhage caused a loss of angle view at insertion site through gonioscopy lens leading to technical difficulties, malposition or abandonment of surgical procedures. Results included intraocular pressure (IOP) at baseline and achieved after 1 week and 4 weeks following the procedure (+/- standard deviation, SD), such as the number of hypotensive drops prescribed at baseline and after 1 month (+/- SD), with a recording of all early post operative complications, associated with a stent site evaluation trough gonioscopy.

22 eyes (21 patients) were reviewed. In two patients the device insertion was abandoned. In 20 patients MINIject^© was inserted (n=10 group A, n=10 group B). Intra-surgical bleeding is reported in 40 % (n=4) of patients in group A, compared with a 70% (n=7) reported in group B (P 0.02). The mean medicated IOP at baseline was 21.7 (+/- 3.8) mmHg that reduced to 12.3 (+/- 4.4) mmHg at week 1, and 12.7 (+/-2.1) at week 4 (P. 0.04). Mean medication drop was, respectively, 2.3 (+/- 0.7) at baseline and 1.25 (+/- 0.8) at week 4 (P 0.05). No statistically difference in bleeding was reported in patients on anticoagulant. There were 2 cases of uveitis, 1 cases of IOP spike, 2 case of hypotony, 2 cases of hyphaemia, all resolved within 4 weeks.

Conclusion: Based on our resultsthe viscoelastic delamination suprachoroidal cleft approach could be considered a safe, reliable and effective way to approach the insertion of the MINIject© supraciliary minimally invasive glaucoma device system implant in order to toimprove surgical view and help with successful devise position in the supracorroidal space.