W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI.
J Glaucoma. 2018 Apr;27(4):e84-e86. doi: 10.1097/IJG.0000000000000897.
To report a case of spontaneous dislocation of a gelatin microstent 6 months after the initial uncomplicated surgery.
We describe a 73-year-old man with a history of advanced primary open-angle glaucoma who had previously undergone an unsuccessful micropulse transcleral cyclophotocoagulation of the left eye. He underwent an uncomplicated combined phacoemulsification with an ab interno gelatin microstent, but was noted to have a spontaneous dislocation of the microstent 6 months postoperatively.
His postoperative course was largely unremarkable. He underwent a total of 5 bleb needlings, 1 immediately postoperatively because of intra-Tenon's positioning of the microstent. At his 6-month follow-up, he had a needling with both 5-flurouracil and subconjunctival bevacizumab. Despite postprocedural gonioscopy confirmation of the microstent positioning, the patient returned 1 week later with a fully dislocated microstent. The dislocation was asymptomatic, and his intraocular pressure remained in the single digits.
The ab interno gelatin microstent is a promising new procedure, but presents unique challenges. As the procedure is still new, more complications are expected to come to light. Although gelatin microstent migration and dislocation appears to be rare, it is important to recognize this postoperative complication. To our knowledge, this is the first report of a spontaneous dislocation of the gelatin microstent without a clear inciting event. This case reiterates the importance of continued follow-up of these cases, and will hopefully help begin to shed light on preoperative considerations and patient selection.
报告一例原发性开角型青光眼患者，在初次手术 6 个月后发生明胶微支架自发性脱位。
我们描述了一名 73 岁男性患者，有晚期原发性开角型青光眼病史，左眼曾行不成功的微脉冲经巩膜睫状体光凝术。他接受了一次不成功的超声乳化白内障吸除术联合内路明胶微支架植入术，但术后 6 个月发现微支架自发性脱位。
他的术后过程基本无异常。他总共进行了 5 次滤泡穿刺术，1 次是因为微支架在 Tenon 囊内定位。在他 6 个月的随访中，他进行了 1 次 5-氟尿嘧啶和玻璃体内贝伐单抗联合治疗。尽管术后行房角镜检查确认了微支架的位置，但患者在 1 周后出现完全脱位的微支架。脱位无症状，眼内压仍保持在个位数。
内路明胶微支架是一种有前途的新技术，但也带来了独特的挑战。由于该手术仍处于初期阶段，预计会有更多的并发症出现。虽然明胶微支架的迁移和脱位似乎很少见，但认识到这种术后并发症很重要。据我们所知，这是首例无明显诱因的明胶微支架自发性脱位的报告。该病例再次强调了对这些病例进行持续随访的重要性，并有望有助于开始阐明术前考虑因素和患者选择。
