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Florian Gekeler, Helmut G. Sachs, Dorothea Besch, Assen Koitschev, Katarina Stingl, Stephanie Hipp, Eberhart Zrenner, Karl Ulrich Bartz-Schmidt; Subretinal Implants: Optimization Of Surgical Technique Without Silicone Oil And Postoperative Intraocular Corrections. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5532.
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Surgery for active subretinal implants has been well established during the last 6 years with safe and stable implantations in 21 patients with retinitis pigmentosa (RP). Surgical focus can now be on post-operative interventions to maximize visual outcome by small adjustments of implant position and on potential improvements such as omission of any endotamponade.
21 patients with RP underwent implantation of a subretinal active implant (Retina Implant AG, Germany). - 2 patients underwent subsequent minimal adjustment of the subretinal position to maximize the area under the macula in an attempt to optimize visual performance. - 1 patient underwent silicone oil exchange with subretinal rtPA 1 week after implantation for subretinal hemorrhage from a postoperative retinal break stemming from retinal injury by the polyimide foil. - 1 patient received only BSS as endotamponade, whereas all other patients had received silicone oil.
All interventions were performed without complications, resulting in the desired chip position and resolution of hemorrhage, respectively; the device remained completely unharmed and functional in all cases. Adjustments of position required neither oil exchange nor other intraocular maneuvers. Retinal integrity was maintained in all cases. - The patient with BSS endotamponade showed attached retina without hemorrhage throughout the postoperative course. - Grating acuity (GA) changed from 0.3 to 1 cpd and from unmeasurable to 0.3 cpd in the cases with position adjustments; GA reached 3.3. cpd in the patient with hemorrhagic episode and 0.33 in the patient without endotamponade (data in the latter only available in the first postoperative week).
Postoperative interventions to adjust the subretinal implant position for optimization of visual function are feasible and can markedly improve visual function. Complications such as a subretinal hemorrhage can be successfully managed. The results in the first patient without silicone oil endotamponade show potential advantages; future evaluation will have to clarify this surgical option.
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