First Simultaneous Explantation and Re-Implantation of an Argus II Retinal Prosthesis System

A 59-year-old blind woman with retinitis pigmentosa had undergone implantation of an Argus II system without complications and took advantage of the system for 7 months. Due to a technical error of the system, the glasses of the prosthesis developed increased heat generation, making the use of the system unbearable. Because of the initial satisfaction and high motivation of the patient, it was decided to strive for an implant exchange. In a 4-hour surgery session, the implant was removed and a new system was implanted. Hereby, several critical surgery steps could be identified that are important to consider for future surgeries. Besides a strong fibrotic scarring of conjunctiva and tenon aggravating the extraction of the extraocular components, the preparation of the sclerotomy proved to be difficult for achieving water tightness. Furthermore, the extraction of the retinal tack and the repositioning of the new array were challenging steps. During the postoperative course, a severe hemorrhagic choroidal detachment occurred but resolved without surgical intervention. The implant was well-placed and showed good function. The exchange of an Argus 11 is feasible, however; with the challenge of hypotony and hemorrhage as well as possible fibrosis complicating the repositioning of the chip.