July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Learning curve of a trained vitreo-retinal surgeon in sub-retinal injections in a rat model: Implications for future clinical trials
Author Affiliations & Notes
  • Vivek Dave
    Vitreoretina, LV Prasad Eye Institute, Hyderabad, Telangana, India
    Center for Ocular Regeneration, LV Prasad Eye Institute, India
  • Praveen Susaimanickam
    Sudhakar and Shreekanth Ravi Stem Cell Biology laboratory, Prof. Brien Holden Eye Research Center, LV Prasad Eye Institute, India
  • Irfan Ahamad Mir
    National Center for Laboratory animal sciences, National Institute of Nutrition, India
  • Indumathi Mariappan
    Sudhakar and Shreekanth Ravi Stem Cell Biology laboratory, Prof. Brien Holden Eye Research Center, LV Prasad Eye Institute, India
  • Savitri Maddileti
    Sudhakar and Shreekanth Ravi Stem Cell Biology laboratory, Prof. Brien Holden Eye Research Center, LV Prasad Eye Institute, India
  • Sayan Basu
    Center for Ocular Regeneration, LV Prasad Eye Institute, India
  • Rajeev Reddy Pappuru
    Vitreoretina, LV Prasad Eye Institute, Hyderabad, Telangana, India
  • Subhadra Jalali
    Vitreoretina, LV Prasad Eye Institute, Hyderabad, Telangana, India
  • Taraprasad Das
    Vitreoretina, LV Prasad Eye Institute, Hyderabad, Telangana, India
  • Footnotes
    Commercial Relationships   Vivek Dave, None; Praveen Susaimanickam, None; Irfan Mir, None; Indumathi Mariappan, None; Savitri Maddileti, None; Sayan Basu, None; Rajeev Pappuru, None; Subhadra Jalali, None; Taraprasad Das, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 3934. doi:
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      Vivek Dave, Praveen Susaimanickam, Irfan Ahamad Mir, Indumathi Mariappan, Savitri Maddileti, Sayan Basu, Rajeev Reddy Pappuru, Subhadra Jalali, Taraprasad Das; Learning curve of a trained vitreo-retinal surgeon in sub-retinal injections in a rat model: Implications for future clinical trials. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3934.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Sub-retinal injections are not very commonly performed procedures in vitreoretina, but form a crucial step in any cell replacement therapy for retinal diseases. The purpose of this study is to describe the learning curve of a trained viteo-retinal surgeon in sub-retinal injections in a rat model and its implications in future clinical trials.

Methods : This is an in-vivo retrospective animal study using Wistar rats.All ARVO guidelines regarding animal handling were followed. After anesthetization, aspectic preparation and dilating the pupils with 1% tropicamide eye drops, subretinal injection of 10µl saline was done via a limbal entry. Data recorded included time taken for the procedure, success of injection, associated complications, post-operative infections and complications. The rats were followed up for 1 month post procedure.A trend analysis was done for the above factors to look for improvement in ease of procedure, reduction in procedure time and reduction in complications for the clinician using a novel objective scale.

Results : Twenty eyes were studied. Mean weight of the rats was 188±12.82 gram. Mean time taken for the procedure was 14.1±5.07 minutes. There was a significant inverse co-relation between the serial number of the eye and time taken for the procedure (r= -0.89, p<0.0001). Comparative complications noted between the first ten and the last ten eyes were : conjunctival tear 30% versus 10% (p=0.27), lens touch 50% versus 10% (p=0.05),subretinal hemorrhage 40% versus 0% (p=0.13), vitreous loss 30% versus 0% (p=0.06).Successful subretinal injection without intraocular complications was achieved in 40% versus 90% (p=0.02). There was a significant co-relation between the serial number of the eye and ease of the procedure (r= 0.87, p<0.0001). Post operatively none of the eyes had any infection. Six eyes (12%) developed cataract and 3 eyes (6%) had non-resolving retinal detachment at the last examination visit.

Conclusions : Subretinal injections in rats have a definite learning curve even for a trained vitreoretinal surgeon. This should be accounted for and resources allocated acordingly to achieve good technical comfort and negate confounding by the surgeon factor in the results of future clinical trials.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

Graph showing the ease of procedure increasing with every subsequent injection

Graph showing the ease of procedure increasing with every subsequent injection

 

Graph showing reducing procedure time with subsequent injections

Graph showing reducing procedure time with subsequent injections

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