Argus II retinal prosthesis malrotation and repositioning with intraoperative optical coherence tomography in a posterior staphyloma.
Argus II retinal prosthesis malrotation and repositioning with intraoperative optical coherence tomography in a posterior staphyloma.
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DOI：
10.2147/opth.s96570
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Hahn P
中科院分区：
文献类型：
--
作者：
Seider MI;Hahn P
Argus II视网膜假体可改善因视网膜色素变性导致严重视力丧失的患者的视功能。电极阵列在黄斑上的最佳居中对于实现最佳视觉结果是重要的。Argus钉旋转不良是一种在放置过程中可能遇到的新实体，尤其是在后葡萄肿患者中。回顾性病例审查。在固定电子阵列期间，发生顺时针旋转，导致错位。我们假设这是继发于在钉插入期间施加的过度旋转或后部压力，以及在先前未识别的后部葡萄肿上的放置。由于提供了横截面图像，术中光学相干断层扫描有助于可视化电子阵列和视网膜之间的距离，这很难单独使用手术显微镜进行评估。通过调整平头钉实现重新定位，但不取出。手术后患者视力改善。在固定Argus II假体时可能会发生旋转不良，并且后葡萄肿的存在可能会增加该风险。区分旋转不良和缝钉错位很重要-前者可以通过阵列不旋转或部分撤回缝钉来解决，后者可能需要取出缝钉并重新插入。此外，术中光学相干断层扫描可能有助于表征手术期间的电子阵列位置。
The Argus II retinal prosthesis may improve visual function in patients with severe vision loss from retinitis pigmentosa. Optimal centration of the electrode array over the macula is important to achieve optimal visual results. Argus tack malrotation is a novel entity that may be encountered during placement, especially in patients with posterior staphyloma. Retrospective case review. During tacking of the electronics array a clockwise rotation occurred resulting in malposition. We hypothesize this was secondary to undue rotation or posterior pressure applied during tack insertion in conjunction with placement over a previously unrecognized posterior staphyloma. Intraoperative optical coherence tomography, because of the cross-sectional images provided, was helpful in visualizing the distance between the electronics array and the retina, which was difficult to assess using the surgical microscope alone. Repositioning was achieved by adjusting the tack without removal. The patient experienced an improvement in vision as a result of the surgery. Malrotation may occur when tacking the Argus II prosthesis, and the presence of a posterior staphyloma may increase this risk. It is important to differentiate malrotation from tack misplacement – the former may be addressed with array unrotation or partial tack withdrawal and the latter may require tack removal and reinsertion. Also, intraoperative optical coherence tomography may be helpful in characterizing electronics array position during surgery.