Habbe Kirsten J, Kohlhaas Markus, Fili Sofia
Department of Ophthalmology at St. Johannes Hospital in Dortmund, Johannesstraße 9-13, 44137, Dortmund, Germany.
Int Ophthalmol. 2024 Feb 9;44(1):45. doi: 10.1007/s10792-024-02993-2.
To describe the in toto explantation of the CyPass® Micro-Stent and its conceivable complications.
This is a case series of eighteen eyes from fourteen patients who underwent CyPass® Micro-Stent implantation due to mild to moderate glaucoma and who subsequently suffered from loss of endothelial cell density. Consequently, the CyPass® Micro-Stent was in toto explanted. The surgical procedure and its complications are described and compared with trimming of the CyPass® Micro-Stent.
A postoperative hyphema was developed in 8 of the 18 eyes. In four of them the hyphema was self-limiting, while in two patients an anterior chamber irrigation was necessary. One patient suffered from a severe intracameral bleeding and iridodialysis during explantation, so that the base of the iris had to be scleral fixated. The remaining explantations were without complications.
Dealing with implanted CyPass® Micro-Stents poses a challenge for ophthalmic surgeons. An in toto removal can be traumatic, since the CyPass stent often is fibrotic encapsulated and fused with the surrounding tissue. Alternatively, trimming of the CyPass is also a viable option to avoid further endothelial damage. Reported complications of CyPass trimming are consistent with those that can occur after explantation. Further data on the development of the endothelial cells after trimming or explantation are not yet available. Therefore, it remains open whether trimming of the CyPass, in contrast to complete removal, carries the risk of further endothelial cell loss.
描述CyPass®微支架的整块取出及其可能出现的并发症。
这是一个病例系列，包含14例患者的18只眼，这些患者因轻至中度青光眼接受了CyPass®微支架植入术，随后出现内皮细胞密度降低。因此，对CyPass®微支架进行了整块取出。描述了手术过程及其并发症，并与CyPass®微支架的修剪情况进行了比较。
18只眼中有8只术后出现前房积血。其中4只眼的前房积血可自行吸收，而2例患者需要进行前房冲洗。1例患者在取出过程中发生严重的前房内出血和虹膜根部离断，因此不得不对虹膜根部进行巩膜固定。其余取出过程均无并发症。
处理植入的CyPass®微支架对眼科医生来说是一项挑战。整块取出可能具有创伤性,因为CyPass支架通常被纤维组织包裹并与周围组织融合。另外，修剪CyPass也是避免进一步内皮损伤的可行选择。报道的CyPass修剪并发症与取出后可能发生的并发症一致。关于修剪或取出后内皮细胞发育的进一步数据尚未可得。因此，与完全取出相比，CyPass修剪是否会有进一步内皮细胞丢失的风险仍不明确。
