Titratable Goniotomies over several clock hrs with the Streamline Surgical System

These videos from Leo Seibold MD and Don Nguyen MD illustrate use of the Streamline Surgical System for creation of incisional goniotomies (CPT code 65820) across several clock hours of trabecular meshwork.
Here are some important features of Streamline to keep in mind:
1. The blue sleeve applanates the trabecular meshwork (TM) and then retracts when the button is depressed. This leads to lifting the TM over the inner cutting cannula thereby producing a precise opening into the canal of Schlemm.
2. The blue sleeve also acts as a guide to center the inner cutting cannula over the canal of Schlemm.
3. The inner cutting cannula, with rounded distal tip, is designed to allow for entry into the canal through the TM without injuring the anterior wall of the canal. Once in the canal, the dual openings allow for injection of viscoelastic 180 degrees apart and across several clock hours of the canal of Schlemm. Applications are repeated as desired by the treating surgeon. This should be coded as 66174 per the AAO when at least three punctures of the TM are completed across 3 or more clock hours with injection of viscoelastic (www.aao.org/practice-manageme....
4. As a separate function, the inner cutting cannula can be used to create incisional goniotomies across several clock hours of TM as titrated by the treating surgeon (see the video for details). The inner cutting cannula is 150um in diameter which is narrower than other catheters used to create incisional goniotomies (like Omni and ABiC, both over 200um). This approach should be coded as 65820 if 3 or more clock hours of TM incision/excision is completed.
5. Streamline allows the surgeon to perform transluminal dilation of the canal of Schlemm across several clock hours. Independently, the device can be used to efficiently titrate goniotomy incisions across several millimeters of the TM. The surgeon chooses the best option for each given patient.
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