Six-card training summary
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Preparation & controls
Stage the instruments Gonio prism, cohesive OVD, miotic, selected anesthesia and OVD-removal equipment.
Know the dilator Slider forward extends the filament; backward retracts. The dial rotates the deployment direction through 360°.
Know the delivery handpiece Actuation releases the scaffold. Reset is for carrier-tip assembly and removal.
Takeaway: Open one dilator and one tissue at a time; keep backup tissue available.
Equipment and chamber preparation
Deck-listed anesthesia options: intracameral lidocaine, retrobulbar, peribulbar or sub-Tenon block, topical, mild sedation, and general anesthesia in special cases. These are options, not a standardized regimen.
Cohesive OVD maintains the anterior chamber. The deck lists I&A or BSS on a syringe for removal.
Miotics are recommended in the draft, especially for standalone procedures. Its sequence calls for full OVD removal from the posterior chamber and capsular bag before miotic use; miotics work best without OVD in the AC. Examples: Miochol and Miostat.
Device features
Elastic nitinol filament mechanically dilates Schlemm’s canal. The draft describes a 240 μm bulbous guide tip.
The outer-wall exfoliator is intended to debride the canal wall during retraction. This is the deck’s mechanism description, not a comparative outcome claim.
Carrier tip houses the preloaded tissue. The draft assembly and sleeve-mechanism slides are placeholders.
Draft note: IFU text and the carrier-assembly sequence are unfinished in the source. Confirm against the current approved materials.
Source slides 4–13, 15–16View & approach
Set the view Head away 35–45°; microscope toward the surgeon 30–40°. Balance the prism lightly and increase magnification.
Identify the landmarks Scleral spur and trabecular meshwork must be clear. Schlemm’s canal lies behind the TM.
Rehearse outside the eye Advance the filament over the eye to plan the path. Adjust seat, scope, wrist and hand support.
Takeaway: The draft asks for a clear view spanning three clock hours and an en face canal approach.
Entry and positioning
Main wound or a secondary side port can provide access. Plan the complete filament excursion before entering the eye.
Maintain finger contact with the actuation slider during approach rehearsal.
The guide asks for an open Shaffer grade 3 or 4 angle without unusual anatomy that would preclude canaloplasty or scaffolding.
Visualization pearls
The draft includes blood reflux into Schlemm’s canal as a localization clue, citing Grieshaber et al., Invest Ophthalmol Vis Sci. 2010;51:1498–1504.
Dry-lab notes emphasize that excess gonio pressure may cause OVD loss and corneal striae, degrading the view.
Draft note: Angle landmarks and visibility guide the approach. The positioning ranges are draft training instructions, not universal anatomy.
Source slides 17–24Canal entry & dilation
Create the opening Use the cannula tip to score ½–1 clock hour of TM, creating a small goniotomy.
Enter under direct view Seat the tip at the goniotomy mouth, angle slightly anterior and advance gently under the TM.
Align, advance, retract After one clock hour, flatten toward the canal, relax the arm, advance 90–180°, then retract with the slider.
Takeaway: Maintain visualization and a steady cannula throughout advancement and retraction.
Sequence for either entry route
The draft describes the same canal sequence for main-wound and side-port access.
Retraction is described as exfoliating the canal outer wall. Speaker notes warn that retraction resistance may pull the cannula inward; hold its position steady.
When passage is uncertain
Speaker notes describe patient verbalization or speculum squeezing as possible cues to a supraciliary dive. Retract and modify the approach rather than interpreting these cues as definitive localization.
The source alternates “perpendicular” and “parallel?” for cannula orientation. That disputed instruction is intentionally not resolved here.
Draft note: Cannula-orientation wording is contradictory on slides 30 and 43. Obtain a verified en face technique demonstration before finalizing this instruction.
Source slides 27–34, 42–43Optional second hemicircle
Withdraw first Remove the cannula from the eye before changing the rotational dial.
Set the backhand approach Rotate the dial and seat at the opposite goniotomy opening.
Repeat the canal sequence Use the same observed advance, realignment and controlled retraction.
Takeaway: The device’s described 360° capability does not make a second hemicircle mandatory.
Backhand approach
Slide 35 describes a slightly anterior initial filament release followed by leveling with a small hand movement.
Forward slider motion delivers the filament; backward motion retracts it. Maintain a steady cannula during retraction.
The source does not provide criteria for choosing total treatment extent or comparative outcomes by extent.
Draft note: The animated circle is an extent schematic, not a calibrated depiction of instrument travel.
Source slides 6–7, 35–36Scaffold delivery & placement
Inspect and seat Check tissue in the carrier tip before entering. Seat at the forehand canal opening and tuck just past the tissue.
Relax and actuate Release torque and pressure into the canal. Press actuation to retract the green sleeve and deliver the scaffold.
Withdraw carefully Back the carrier out and around to avoid enlarging the goniotomy; verify scaffold placement.
Takeaway: Carrier withdrawal must preserve the opening and avoid releasing tissue into the anterior chamber.
Placement observations
The draft notes that tissue may remain visible in Schlemm’s canal.
Slide 41 states tissue expands 2–3×. It does not define the measurement axis, hydration conditions or timing, so no quantitative expansion animation is shown.
Source placement photograph can be opened below.
Delivery troubleshooting
If tissue does not release, relax pressure and torque, shoulder and hand. The draft asks the operator to check that the tip is not tucked too deeply.
The draft lists replacement with a new carrier tip when needed. Assembly details must come from the completed training/IFU materials.
Draft note: The sleeve animation is a labeled mechanism schematic. Assembly, expansion specifications and release-failure handling need current source confirmation.
Source slides 11–13, 38–42Situations
Filament stalls or dives Retract, realign and reassess the en face view and wrist position. The draft offers an upstream approach change for failed advancement.
Delivery resists Release pressure/torque, relax the hand and shoulder, and reassess seating depth. Use the verified replacement-carrier workflow if needed.
Practice the full sequence Rehearse approach, incision/goniotomy, dilation and tissue placement in open-sky and closed-dome models.
Takeaway: Track visualization, hand support and tissue placement. Resolve source gaps before live-case training.
Dry-lab sequence
Open sky: rotate the model to rehearse the approach; mark the cannula position as the intended incision. Lay the model flat and practice the planned entry, goniotomy, dilation and tissue placement.
Closed dome: rehearse and mark the approach, create an incision, fill with OVD, then practice the complete sequence. The draft’s “side-port blade or 2.2” wording is incomplete and does not establish a verified incision specification.
Trainer checks: grip and wrist, prism pressure, shoulder/arm support and comfort. Record where further practice is needed.
Coverage and missing training
The source has no completed indication/contraindication IFU excerpt, assembly media, formal bailout algorithm, completion protocol or postoperative regimen. These cards do not invent those instructions.
Slide 45 is an operative-note placeholder. Slide 46 contains reimbursement figures that have not been validated here and are outside these procedural cards.
Slide 11 speaker notes repeat an exfoliation description from the dilator section; they do not provide additional carrier-assembly instructions.
Draft note: The six-card summary supports draft review and supervised rehearsal. It cannot replace completed IFU, approved training or surgical judgment.
Source slides 29, 34, 43–46