Retinal Prostheses: Surgical Techniques and Postoperative Management

Abstract

The Argus® II surgical implantation is performed under general anesthesia with an average duration of 3 h. Both standard vitreoretinal tools and specifically designed surgical instruments are used. A series of tools has been carefully selected to allow the clinician to grab and easily manipulate the implant during the surgical maneuvers. After careful sterile preparation of the eye, a 360° limbal conjunctival peritomy is performed, and the rectus muscles are isolated. The coil is centered under the lateral rectus muscle and the electronic case in the supero-temporal quadrant. The scleral band is passed under recti muscles. The implant is fixed to the eye via sutures passed through suture tabs and a Watzke sleeve and mattress sutures used to secure the scleral band in the nasal quadrants. A core and peripheral vitrectomy are conducted. If an epiretinal membrane or posterior hyaloid is observed is peeled. The array is then inserted through a supero-temporal 5.2 sclerotomy. The electrode array is placed onto the retina in the macular region and then tacked using a retinal tack. The extraocular portion of the cable is sutured to the sclera, and all sclerotomies are closed. An allograft (or suitable alternative) is fixed over the electronic package. Finally, the Tenon’s capsule and the conjunctiva are closed. Intravitreal antibiotics are injected prior to close. In the postoperative management, regular eye checkups, microarray calibration, and patient rehabilitation are performed.