A growing number of vitreoretinal surgeons are successfully implanting the Argus II Retinal Prosthesis (Second Sight Medical Products, Sylmar, CA) to provide electrical stimulation of the retina, allowing individuals blind from retinitis pigmentosa the ability to perceive visual information. As more vitreoretinal surgeons implant the device, the need to learn from shared challenges in implantation and new techniques to surmount these hurdles increases.
We present a technique to deal with difficult intraocular placement of the electrode array through a sclerotomy in a patient with retinitis pigmentosa and Marfan's syndrome. The uveal tissue persistently prolapsed through the sclerotomy making intraocular placement of the electrode array challenging.
After the extraocular portion of the Argus II Retinal Prosthesis is secured to the sclera, a 5.2-mm sclerotomy is made in the superotemporal quadrant. Using the Eckardt forceps to grasp the array at its positioning handle, intraocular positioning of the device was attempted. However, uveal tissue prolapsed from the sclerotomy and impeded successful placement of the array. The uveal tissue surrounded the array as attempts were made to insert the device. Attempts to reposit the uveal tissue by using various maneuvers including use of a blunt cannula, decreasing the intraocular pressure, and use of healon were unsuccessful.
A Sheets glide (BD Visitec IOL Glide; Beaver-Visitec International, Waltham, MA) was inserted into the sclerotomy. The electrode array was then successfully maneuvered into the sclerotomy without the prolapse of uveal tissue. The Sheets glide provided a smooth surface along which to insert the electrode array and prevent further prolapse of uveal tissue from hindering the intraocular entry.
A Sheets glide is a soft, flexible plastic strip commonly used by anterior segment surgeons to aid in the placement of an anterior chamber intraocular lens. It provides a smooth surface on which to ease intraocular placement of implants.1,2 As it is 5 mm wide, it fits nicely into the sclerotomy made for the Argus II and can facilitate the implantation of an electrode array in a patient with uveal prolapse. This plastic surface is soft and safe for both maneuvering the electrode array and placing it in the vitreous cavity.
This technique may also be used to help facilitate intraocular placement of the Argus II electrode array in patients without uveal prolapse. The patient seen in our Supplemental Video (See Video below) had Marfan's syndrome, which may have contributed to the tendency for uveal prolapse. We postulate patients with thin or collapsible sclera may also benefit from a Sheets glide-assisted implantation of the electrode array. By using the Sheets glide, the surgeon can avoid excessive manipulation of the sclerotomy, which may lead to difficult closure and postoperative hypotony. Additionally, our standard technique is to close the sclerotomy with interrupted 9-0 prolene, which is nonabsorbable and more resilient to degradation. There was no postoperative wound leak in this case.
- Sheets JH, Maida JW. Lens glide in implant surgery. Arch Ophthalmol. 1978;96(1):145–146. doi:10.1001/archopht.1978.03910050095024 [CrossRef]
- Maida J, Sheets JH. A lens glide punch. Arch Ophthalmol. 1978;96(5):898. doi:10.1001/archopht.1978.03910050500023 [CrossRef]