{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T20:33:05Z","timestamp":1787776385896,"version":"build-2784847793"},"reference-count":2,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"Suppl 3","license":[{"start":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T00:00:00Z","timestamp":1748563200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:p>The key challenge of implanting the hydrus glaucoma microstent is avoiding the tip from exiting Schlemm\u2019s canal and diving posteriorly toward the iris root. Here, we propose a novel theory as to why the hydrus stent tends to dive posteriorly and we describe surgical steps to prevent this from occurring. These steps include making a corneal incision oriented tangential to the angle, having a flat angle of attack to Schlemm\u2019s canal, and relaxing the hand before advancing the stent. Observing a gap between the stent and the back wall of the hydrus injector (\u201cgap sign\u201d) indicates that the stent is striking the back wall of Schlemm\u2019s canal and is likely to dive posteriorly unless the surgeon\u2019s hand position is adjusted.<\/jats:p>","DOI":"10.4103\/ijo.ijo_2649_24","type":"journal-article","created":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T05:00:40Z","timestamp":1748581240000},"page":"S515-S516","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Surgical technique to prevent malposition of the Hydrus glaucoma microstent (The \u201cgap sign\u201d)"],"prefix":"10.4103","volume":"73","author":[{"given":"Nicholas H","family":"Andrew","sequence":"first","affiliation":[{"name":"Sight Specialists, Gold Coast, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malak","family":"Habib","sequence":"additional","affiliation":[{"name":"School of Medicine and Dentistry, Griffith University, Gold Coast, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,5,30]]},"reference":[{"key":"R1-20260422","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.ophtha.2018.05.012","article-title":"A Schlemm canal microstent for intraocular pressure reduction in primary open-angle glaucoma and cataract: The HORIZON study","volume":"126","author":"Samuelson","year":"2019","journal-title":"Ophthalmology"},{"key":"R2-20260422","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.survophthal.2019.08.002","article-title":"A review of aqueous outflow resistance and its relevance to microinvasive glaucoma surgery","volume":"65","author":"Andrew","year":"2020","journal-title":"Surv Ophthalmol"}],"container-title":["Indian Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/IJO.IJO_2649_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T20:09:52Z","timestamp":1787774992000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/IJO.IJO_2649_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,30]]},"references-count":2,"journal-issue":{"issue":"Suppl 3","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/ijo.ijo_2649_24","relation":{},"ISSN":["0301-4738","1998-3689"],"issn-type":[{"value":"0301-4738","type":"print"},{"value":"1998-3689","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,30]]},"assertion":[{"value":"2024-11-05","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-10","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}