Intraoperative optical coherence tomography (iOCT) is increasingly being adopted in glaucoma surgery and more recently in minimally invasive glaucoma surgery (MIGS). In angle-based MIGS, surgical precision is critical yet particularly challenging, given the difficulty in visualization within the small space of the angle. This video demonstrates how iOCT can assist in the implantation and optimal placement of 2 trabecular bypass MIGS devices: the iStent inject W and the Hydrus microstent. Intraoperative OCT helps the beginning surgeon avoid inadvertent underimplantation of the iStent inject W, which can occur due to poorer appreciation of the proximity between the trabecular meshwork (TM) surface and the underside of the larger-diameter flange in this latest-generation iStent. Intraoperative OCT can also help ensure optimal placement of the Hydrus microstent behind a very densely pigmented TM, which precludes direct visualization of the 3 blood-filled microstent windows in the Schlemm canal. In this video, features on the iOCT images are correlated with specific components of the trabecular bypass devices in situ.

Financial Disclosures: Dr. Bryan Ang discloses relationships with Abbvie (Consultant/Advisor); Alcon Laboratories, Inc. (Consultant/Advisor, Lecture Fees/Speakers Bureau), Allergan, Inc. (Consultant/Advisor, Lecture Fees/Speakers Bureau, Grant Support), Carl Zeiss Meditec (Consultant/Advisor, Lecture Fees/Speakers Bureau), 
and Glaukos Corporation (Consultant/Advisor, Lecture Fees/Speakers Bureau, Grant Support).