VISCO360 Viscosurgical System

Sight Sciences

A procedure based surgical intervention that facilitates an ab interno approach for controlled viscodilation of Schlemm canal and viscoelastic-assisted dissection within the anterior segment

Nathan Radcliffe

Nathan Radcliffe, MD

Glaucoma Specialist and Cataract Surgeon, New York Eye Surgery Center

Expert Reviewer

At-a-Glance
  • Controlled entirely by the surgeon and can be used in viscodilation of Schlemm canal and any application of viscoelastic-assisted dissection within the anterior segment
  • Easy-to-use roller wheel mechanism simultaneously retracts the microcatheter and triggers the internally integrated pump mechanism to deliver a predetermined amount of viscoelastic
  • Can be used in a stand-alone procedure or in conjunction with cataract or other anterior segment surgeries
  • The single-use instrument does not require a capital investment and is reimbursed under a Category I CPT code

The VISCO360 Viscosurgical System can be used for a variety of viscoelastic-assisted dissection techniques within the anterior segment, but most notably allows surgeons to restore normal aqueous outflow through viscodilation of 360° of Schlemm canal and collector channels through a single clear corneal incision. The instrument’s intelligent design is rooted in the integrated handpiece which bestows utility and ergonomically comfortable use. A control wheel advances a semi-rigid, blunt polymer microcatheter through the tip of a curved cannula while reverse actuation of the wheel retracts the microcatheter and activates the internal infusion pump, which automatically deposits a predetermined amount of viscoelastic.

Operation of the device is manually controlled by the surgeon. Built-in mechanisms and precision engineering allow for one-handed control which minimizes the number of additional instruments or scrub nurse assistance. When used in microinvasive glaucoma surgery (MIGS), the single-use instrument uniquely provides ab interno access to 360° of Schlemm canal through a single incision (180° accessed superiorly and 180° inferiorly). As the indication states, the VISCO360 can also be used in any other anterior segment surgical technique that calls for delivery of small amounts of viscoelastic fluid, such as viscoelastic-assisted synechiolysis, IOL capsular dissection, or cyclodialysis.

Controlled delivery of viscoelastic to Schlemm canal and collector channels

Expanding Aqueous Outflow

VISCO360’s unique mechanism and broad labeling make it a viable option to address aqueous outflow in patients with mild to severe glaucoma during cataract surgery or as a stand-alone procedure. It was specifically designed to access 360° of Schlemm canal in an ab interno procedure through one small corneal incision. The cannula tip is used to create an entry point in the trabecular meshwork and the microcatheter is advanced 180° through Schlemm canal by dialing the control wheel. Reverse actuation of the control wheel simultaneously delivers a controlled volume of viscoelastic fluid to viscodilate the canal and open collapsed collector channels as the device is retracted. The device is removed from the eye, flipped, and the procedure is repeated on the other 180°. Additionally, the nature of this procedure leaves the opportunity open for future trabeculectomies, goniotomies, stent placements, or more aggressive treatments if needed.

Use of VISCO360 in interventional glaucoma surgery is billable under the Category I Current Procedural Terminology (CPT) code 66174 (Transluminal dilation of aqueous outflow canal; without retention of device or stent). In 2017, the Medicare allowable reimbursement amounts for 66174 were:

  • $1,747 for ambulatory surgery centers (ASC)
  • $3,417 for hospital outpatient departments (HOPD
  • $964 for the physician

System Tour



RESERVIOR AND INFUSION PUMP

Reverse actuation of the control wheel simultaneously retracts the microcatheter and automatically delivers a controlled volume of viscoelastic fluid



CONTROL WHEEL

Roller gear mechanism facilitates single-handed control of forward and backward movement of the microcatheter



CANNULA

Enables controlled placement of the microcatheter through a small clear corneal incision and can be used to pierce trabecular meshwork for entry into the canal



MICROCATHETER

The flexible blunt polymer microcatheter can be advanced through approximately 180° of Schlemm canal or used to mechanically cleave synechiae



VISCOELASTIC FLUID

The device is loaded with the preferred brand of viscoelastic fluid such as Healon or HealonGV (Abbott), Amvisc (Bausch & Lomb), or PROVISC (Alcon)

RESERVIOR AND INFUSION PUMP

Enables controlled placement of the microcatheter through a small clear corneal incision and can be used to pierce trabecular meshwork for entry into the canal.

CONTROL WHEEL

Enables controlled placement of the microcatheter through a small clear corneal incision and can be used to pierce trabecular meshwork for entry into the canal.

RESERVIOR AND INFUSION PUMP

Enables controlled placement of the microcatheter through a small clear corneal incision and can be used to pierce trabecular meshwork for entry into the canal.

CANNULA

Enables controlled placement of the microcatheter through a small clear corneal incision and can be used to pierce trabecular meshwork for entry into the canal.

MICROCATHETER

Enables controlled placement of the microcatheter through a small clear corneal incision and can be used to pierce trabecular meshwork for entry into the canal.

VISCOELASTIC FLUID

Enables controlled placement of the microcatheter through a small clear corneal incision and can be used to pierce trabecular meshwork for entry into the canal.

Testimonials

My patients and I have benefited greatly from my use of the VISCO360 procedure based surgical intervention to perform ab interno canaloplasty.

My outcomes have been excellent, allowing remarkable safety, excellent and rapid visual recovery, and the reduction of both IOP and medications in a wide range of patients with open angle glaucoma.

Nathan Radcliffe, MD

New York Eye Surgery Center

Details

FDA

Yes

CE Mark

Yes

Classification

Ab interno

Mechanism of Action

Microcatheterization and viscodilation of Schlemm canal and collapsed collector channels

Indication

The VISCO360 Viscosurgical System is indicated for the delivery of small amounts of viscoelastic fluid such as Healon or HealonGV from Abbott Medical Optics (AMO), Amvisc from Bausch & Lomb, or PROVISC from Alcon during ophthalmic surgery

Usage

Treatment of mild to severe glaucoma during cataract surgery or as a stand-alone procedure and viscoelastic-assisted dissection techniques within the anterior segment

From Your Peers

The Visco360 is an implant-free, single-handed, microcatheter surgical system designed to deliver small amounts of ophthalmic viscosurgical device during surgery. It also employs an ab interno approach, which spares the conjunctiva and sclera from incisions.

Glaucoma Today, January 2017

Steven D. Vold, MD

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