Sachdeva Neha, Sun Lynn W, Young Jonathan, Chen Aiyin
Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA.
NVISION Eye Center, Tigard, Oregon, USA.
Am J Ophthalmol Case Rep. 2024 Jul 20;36:102105. doi: 10.1016/j.ajoc.2024.102105. eCollection 2024 Dec.
The Hydrus microstent was approved by the FDA in August 2018 for use with cataract surgery to reduce IOP in patients with mild to moderate primary open angle glaucoma (POAG). Pivotal clinical trials demonstrated its overall safety and efficacy in lowering IOP. However, malpositioning of the implant can result in uveitis-glaucoma-hyphema (UGH) syndrome necessitating device explantation. Here we report four such cases and their associated challenges. We also highlight the importance of early recognition of post-operative complications for ease of implant removal.
Case 1: A 75-year-old female patient was referred for chronic granulomatous anterior uveitis with cystoid macular edema (CME) and uncontrolled IOP in the left eye after cataract extraction with Hydrus implantation. On gonioscopy, the implant was occluded and embedded in the iris. The patient underwent removal of the Hydrus implant 10 months after the initial surgery with canaloplasty to control IOP.Case 2: A 71-year-old male patient on dual anti-platelet developed intraoperative hyphema during cataract extraction with Hydrus microstent in the right eye. Post-operatively, clopidogrel was stopped, but hyphema persisted with uncontrolled IOP. The Hydrus was noted to be syneched against the iris face. The patient underwent anterior chamber washout with Hydrus explantation and Ahmed glaucoma valve implantation 16 days after the first surgery.Case 3: A 76-year-old patient developed persistent granulomatous anterior uveitis in the left eye after cataract extraction with Hydrus microstent. On gonioscopy, the Hydrus ostium was seen resting on the iris without occlusion, and the patient underwent Hydrus removal with nasal goniotomy 3 months after initial surgery.Case 4: A 63-year-old patient underwent cataract extraction with endoscopic cyclophotocoagulation and a complex Hydrus microstent implantation requiring multiple attempts. Eleven months later, the patient was found to have uveitis-glaucoma-hyphema syndrome and macular edema, and the Hydrus was noted to be insufficiently inserted and posteriorly rotated with contact against the iris. The Hydrus was explanted, and nasal goniotomy was performed.
Hydrus microstents that are malpositioned can result in persistent uveitis-glaucoma-hyphema syndrome. Explantation between 2 weeks and 11 months successfully resolved post-operative uveitis and hyphema, but all cases required additional glaucoma-hyphema syndrome. Early recognition is important since late removal was more challenging due to the implant becoming embedded in the iris.
Hydrus微支架于2018年8月获美国食品药品监督管理局（FDA）批准，可用于白内障手术，以降低轻度至中度原发性开角型青光眼（POAG）患者的眼压。关键临床试验证明了其降低眼压的总体安全性和有效性。然而，植入物位置不当可导致葡萄膜炎-青光眼-前房积血（UGH）综合征，需要取出装置。在此，我们报告4例此类病例及其相关挑战。我们还强调了早期识别术后并发症对于便于取出植入物的重要性。
病例1：一名75岁女性患者因左眼植入Hydrus后白内障摘除术后出现慢性肉芽肿性前葡萄膜炎伴黄斑囊样水肿（CME）且眼压控制不佳而前来就诊。房角镜检查显示，植入物被堵塞并嵌入虹膜。患者在初次手术后10个月接受了Hydrus植入物取出术及房角成形术以控制眼压。病例2：一名71岁男性患者在右眼白内障摘除术中植入Hydrus微支架时出现术中前房积血，该患者正在接受双联抗血小板治疗。术后，氯吡格雷停药，但前房积血持续存在且眼压控制不佳。发现Hydrus与虹膜面粘连。患者在首次手术后16天接受了前房冲洗、Hydrus取出术及艾哈迈德青光眼引流阀植入术。病例3：一名76岁患者在植入Hydrus微支架的白内障摘除术后左眼出现持续性肉芽肿性前葡萄膜炎。房角镜检查显示，Hydrus开口位于虹膜上且未堵塞，患者在初次手术后3个月接受了Hydrus取出术及鼻侧房角切开术。病例4：一名63岁患者接受了白内障摘除术、内镜睫状体光凝术及复杂的Hydrus微支架植入术，植入过程需要多次尝试。11个月后，该患者被发现患有葡萄膜炎-青光眼-前房积血综合征及黄斑水肿，发现Hydrus植入不足且向后旋转并与虹膜接触。Hydrus被取出，并进行了鼻侧房角切开术。
位置不当的Hydrus微支架可导致持续性葡萄膜炎-青光眼-前房积血综合征。在2周至11个月之间取出植入物成功解决了术后葡萄膜炎和前房积血问题，但所有病例均需要额外治疗青光眼-前房积血综合征。早期识别很重要，因为由于植入物嵌入虹膜，晚期取出更具挑战性。
