This clinical photographic sequence illustrates the three critical surgical steps of an ab-externo XEN gel stent implantation, a minimally invasive glaucoma surgery (MIGS). Panel A shows the initial conjunctival insertion, where the injector needle is positioned approximately 7 mm posterior to the limbus, stabilized by conjunctival forceps. Panel B depicts the scleral entry phase, with the needle advancing through the scleral tissue approximately 2.5 mm behind the limbus at a shallow angle. Panel C demonstrates the final intraocular positioning, where the injector tip has penetrated into the anterior chamber, visible through the clear cornea. Throughout the procedure, the bulbar conjunctiva shows significant vascular engorgement and localized subconjunctival hemorrhage at the entry sites, which are typical findings. Blue surgical markings on the sclera indicate the measured distances for precise entry. This sequence serves as an educational guide for ophthalmology trainees on the external-to-internal approach for glaucoma drainage device placement.

This clinical photograph displays two panels (A and B) showcasing the surgical steps of Bent Ab interno Needle Goniotomy (BANG), a minimally invasive glaucoma surgery (MIGS). The images are captured through a surgical gonioscopy lens, which provides a clear, magnified view of the anterior chamber angle of the eye. In Panel A, a 25-gauge angled needle tip is shown making contact with and penetrating the nasal trabecular meshwork. The needle is positioned to access Schlemm's canal. In Panel B, the post-incisional result is visible, demonstrating a 90-degree sectoral excision of the trabecular meshwork across the superonasal, nasal, and inferonasal quadrants. The surgical lens appears as a transparent, dome-shaped interface on the corneal surface. This educational visual illustrates the precise anatomical targeting required to enhance aqueous humor outflow in the management of intraocular pressure. The imagery is intended for advanced ophthalmology education, specifically focusing on surgical techniques for glaucoma treatment.

This sequence of three clinical intraoperative photographs (labeled A, B, and C) demonstrates the stages of an ab-interno laser glaucoma procedure in a lab setting. Panel A shows the initial subconjunctival injection of mitomycin C (MMC), resulting in a localized, dark, fluid-filled bleb intended to inhibit postoperative fibrosis. Panels B and C illustrate the surgical approach using a 2940nm Er:YAG thermal-ablating laser system. In Panel B, a thin laser probe is inserted into the anterior chamber through a 1mm clear corneal incision, positioned across the iris plane. Panel C depicts the advancement of the laser probe to perform tissue ablation at the trabecular meshwork, creating a permanent drainage channel (scleral tunnel) from the anterior chamber to the subconjunctival space. The images highlight key landmarks including the cornea, iris, and the surgical instrumentation. This material is designed for advanced ophthalmic surgical training, focusing on minimally invasive glaucoma surgery (MIGS) techniques and the use of adjunct antimetabolites in filtration procedures.

This clinical photograph is an intraoperative view of an ophthalmic surgical procedure, specifically a XEN Gel Stent implantation for glaucoma management. The image displays the anterior segment of the eye with a thin, metallic injector inserted through a temporal-inferior side port incision. The injector traverses the anterior chamber, with its distal tip positioned approximately 2 mm posterior to the corneal limbus, residing underneath the conjunctiva to facilitate the ab interno creation of a subconjunctival drainage bleb. The conjunctiva shows localized vascular congestion and mild erythema, consistent with surgical manipulation and the administration of mitomycin C. The cornea remains relatively transparent but exhibits surface reflections and minor irregularities likely due to the application of viscoelastic substances. Small air bubbles are visible within the fluid-filled space above the cornea. This visual demonstrates the precise needle-passing technique required to bridge the anterior chamber and the subconjunctival space to ensure proper stent placement for intraocular pressure reduction.

This clinical procedural image consists of two panels (A and B) demonstrating the intraoperative steps of Gonioscopy-Assisted Transluminal Trabeculotomy (GATT), a minimally invasive glaucoma surgery (MIGS). The view is obtained via an ab interno approach through a surgical goniolens, visualizing the nasal anterior chamber angle. Panel A shows the initial step where a 25-gauge needle is used to create a focal goniotomy, incising the trabecular meshwork to expose the underlying Schlemm's canal. Panel B illustrates the subsequent cannulation phase, where a 5-0 Prolene (polypropylene) suture wire is inserted through the goniotomy and advanced 360 degrees into the lumen of Schlemm's canal, guided by 23-gauge microforceps. Key anatomical landmarks visible include the clear cornea with surgical air bubbles, the pigmented trabecular meshwork band, and the iris periphery. This procedure is performed to reduce intraocular pressure by bypassing the primary site of aqueous outflow resistance.