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R. Tano, P.A. A. Mello–Filho, D. Guven, T. Ratanapakorn, N.R. F. Beeley, E. de Juan, Jr, S.E. Varner; Helical Intravitreal Triamcinolone Implant : Surgical Method Development and Outcomes . Invest. Ophthalmol. Vis. Sci. 2005;46(13):483.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To investigate outcomes of a surgical method for implanting a helical intravitreal implant. Methods: Sustained release implants containing 925 mcg of triamcinolone acetonide were placed in 112 eyes of 82 rabbits and followed clinically for up to 6 mos (6 mos (15 eyes), 3 mos (73 eyes), 6 wks (12 eyes), 4 wks (10 eyes), and 1 wk (2 eyes)). The implant was positioned intravitreally by insertion through the sclera, 3 mm from the limbus, following a 3–mm conjunctival and Tenon dissection in the superotemporal quadrant. Full– or half–thickness sclerotomies were performed with a 30 g needle before implantation. The implant was rotated through the sclerotomy using a custom surgical instrument. Once the implant cap firmly abutted the sclera, the conjunctiva was closed with 1 or 2 absorbable sutures. To assess clinical complications of implantation, macroscopic superficial findings and indirect ophthalmoscopic examination were performed, and IOP was measured, pre– and postoperatively. Results: The entire implantation procedure consistently took 15–20 min. No extrusion or migration of the implants were observed in up to 6 mos of follow–up. At 6 mos, focal superotemporal cataracts were observed in 10 of 15 eyes (67%): these were attributed to contact between the relatively large and posterior rabbit lens and the implant tip. Pigmented debris on the tip of coil was observed in 15 eyes (13%) immediately after the procedure. Mild vitreous hemorrhage was observed in 31 eyes (28%) immediately postop, but it did not interfer with fundus visualization. IOP was stable between baseline and 1 wk postop. No differences were seen between the full– and half–thickness sclerotomy groups. One case of infectious endophthalmitis was seen at 17 days (0.89% incidence). No retinal hemorrhage, tears, or detachment were seen during this study. Conclusions: The helical implant was safely inserted using custom surgical instruments. The 15–20 min procedure was relatively straightforward. Other than 1 case of endophthalmitis, no surgical complications were observed.
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