Fig. 5

Surgical procedure for MicroShunt implantation. (Adapted from Pinchuk L, et al. Regen Biomater. 2016;3:137–42 [7].) 1. Anesthetic is administered beneath the conjunctiva (anesthetic can be injected locally or as a peribulbar block, or applied topically); 2. An incision is made parallel to the limbus and under Tenon’s capsule; 3. Blunt scissors are used to dissect the Tenon’s from the sclera over one to two quadrants and deep to the equator; 4. Following hemostasis using bipolar diathermy (not shown), MMC-soaked sponges are placed in the pocket, which is then rinsed with sterile saline solution; 5. A 1 mm-wide, 1–2 mm-long shallow scleral pocket is made 3 mm posterior to the limbus; 6. A needle is passed through the scleral pocket into the anterior chamber, approximately bisecting the cornea and iris at the level of the trabecular meshwork;^a 7. The MicroShunt is threaded through the pocket and needle tunnel with forceps, and the fins of the device are wedged into the scleral pocket; 8. The flow of aqueous humor from the anterior chamber to the flap is confirmed by drop observation; 9. The distal end of the device is tucked beneath the conjunctiva and Tenon’s capsule which are then pulled over the MicroShunt and sutured back to the limbus with 10–0 nylon sutures ^aThis step is consistent with the EU labeling; in the USA, a double-step knife is used instead of a needle to create the tunnel into the anterior chamber [13]. MMC = Mitomycin C.