Medra Ahmed, Schwanengel Mathias, Weber Annegret, Brinkmann Christian Karl
Klinik für Augenheilkunde, Dietrich-Bonhoeffer-Klinikum Neubrandenburg, Salvador-Allende-Str. 30, 17036, Neubrandenburg, Deutschland.
Ophthalmologe. 2020 Dec;117(12):1241-1246. doi: 10.1007/s00347-020-01247-7.
The indications for CyPass trimming are based on the standard protocol for endothelial protection of the Department of Ophthalmology at the Dietrich Bonhoeffer Hospital Neubrandenburg. The CyPass stent should be shortened to a maximum reach up to the scleral spur.
The indications for CyPass trimming are based on two main criteria: the position of the CyPass in relation to the structures of the anterior chamber angle and the presence of corneal endothelial cell loss.
There are no contraindications.
The operation shown in the video available online is performed with the patient under local anesthesia. The incisions are created individually and depend on the position of the CyPass stent. Through a 1.2 mm corneal paracentesis opposite to the stent, the anterior chamber is filled with a cohesive viscoelastic material and the stent is stabilized with a 20-gauge vitreous forceps and then cut with 20-gauge bent vitreous scissors through another 1.4-1.8 mm paracentesis, 3-4 h away from the stent visualized by gonioscopy. In some cases, surgical goniosynechiolysis in the area of the stent is required. The anterior end of the stent is cut as deep as possible. After aspiration of the viscoelastic material and possibly blood, the anterior chamber is toned with balanced salt solution (BSS) and the paracenteses are hydrated. Corneal suturing is not necessary.
Up to November 2019 65 CyPass stents in 64 eyes have been trimmed using this method. Iridodialysis occurred in 1 eye, in 12 eyes slight self-limiting bleeding and in 2 eyes an iris defect.
The procedure shown enables a safe microsurgical shortening of the CyPass stent with few complications. The risk of intraoperative expulsive bleeding or postoperative fistulation is markedly reduced.
CyPass修剪的指征基于新勃兰登堡迪特里希·朋霍费尔医院眼科内皮保护的标准方案。CyPass支架应缩短至最大长度，直至巩膜突。
CyPass修剪的指征基于两个主要标准：CyPass相对于前房角结构的位置以及角膜内皮细胞丢失的情况。
无禁忌证。
在线视频中展示的手术在患者局部麻醉下进行。切口根据CyPass支架的位置单独制作。通过与支架相对的1.2毫米角膜穿刺口，向前房注入粘性粘弹剂，并用20号玻璃体镊稳定支架，然后通过距前房角镜可见的支架3-4小时处的另一个1.4-1.8毫米穿刺口，用20号弯玻璃体剪切断支架。在某些情况下，需要在支架区域进行手术性虹膜粘连分离术。尽可能深地切断支架的前端。吸出粘弹剂及可能的血液后，用平衡盐溶液（BSS）调节前房，穿刺口水化。无需角膜缝合。
截至2019年11月，已使用该方法对64只眼中的65个CyPass支架进行了修剪。1只眼发生虹膜根部离断，12只眼有轻微自限性出血，2只眼有虹膜缺损。
所示手术方法可安全地通过显微手术缩短CyPass支架，并发症少。术中爆发性出血或术后形成瘘管的风险明显降低。
