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HG Sachs, VP Gabel; Endoscopic Transscleral Subretinal Surgery (ETSS) in the Minipig Model: First Experimental Data . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3535.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: Subretinal Surgery is limited by poor visual control of the surgical action due to the missing transparency of the detached retina when observing transpupillar. Endoscopic subretinal surgery in conventional ppV has disadvantages resulting from two fix points of the instrument (sclerostomy, retinotomy). Surgical maneuvers are therefore limited. Methods: A combined surgical procedure consisting of a ppV and a transscleral procedure is made use of. The region for the transscleral subretinal access is marked on the scleral surface like in buckle surgery. Then after complete vitrectomy the retina is detached in the corresponding area by BSS injected with a teflon canula. Viscoelastic solution is injected in the subretinal bleb to stabilize the situation for the transscleral access and to protect the retina. The globe is rotated and additional ports into the subretinal space can be added in the prior marked region were the retina is detached. A GRIN endoscope is inserted to get visual control of the subretinal space. Other ports in this region are used to insert instruments. When finishing surgery subretinal used fluids are removed mainly transsclerally, ports a sutured conventionally. Remaining rests of the subretinal fluids can be removed after switching back to vitrectomy through the small retinotomy. Retina is reattached conventionally with gas. Results: The Yucatan micropigs which were treated using this procedure did not show extensive bleedings from the choroid. Surgical maneuver could be carried out under good visibility. The posterior pole was good accessible during surgery. Trauma to the retina is minimal in this procedure. Conclusion: Subretinal or submacular surgery can be carried out under full visual control of all maneuver thus minimizing trauma to retina or the pigment epithelium.
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