Hints for Gentle Submacular Injection in Non-Human Primates Based on Intraoperative OCT Guidance
| Autor: | Tanja Ilmarinen, Veluchamy A. Barathi, Boris V. Stanzel, Gopal Lingam, Caroline Chee, Zengping Liu, Gavin Tan, Xinyi Su |
|---|---|
| Přispěvatelé: | Tampere University, BioMediTech |
| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
Primates medicine.medical_specialty Intraocular pressure genetic structures medicine.medical_treatment Biomedical Engineering Visual Acuity Vitrectomy Article 03 medical and health sciences 0302 clinical medicine Foveal Advanced Therapy Medicinal Products Ophthalmology Medicine Animals Macula Lutea Macular edema business.industry Fovea centralis Macular degeneration medicine.disease eye diseases 030104 developmental biology medicine.anatomical_structure submacular surgery 030221 ophthalmology & optometry intraoperative OCT Tamponade 3111 Biomedicine sense organs Bleb (medicine) non-human primates business Tomography Optical Coherence fovea |
| Zdroj: | Translational Vision Science & Technology |
| ISSN: | 2164-2591 |
| Popis: | Purpose: Delivery of Advanced Therapy Medicinal Products to the submacular space is increasingly evolving into a therapeutic modality. Cell replacement for age-related macular degeneration (AMD) and gene therapy for RPE65 are recent successful examples. Herein, a nonhuman primate (NHP) model was used to investigate surgical means to detach the macula. Methods: Sixteen eyes of 13 healthy macaques underwent a 25-gauge vitrectomy and subretinal injection of balanced salt solution monitored by microscope-integrated intra-operative optical coherence tomography (miOCT). The animals were followed with OCT and histology. Results: The miOCT monitoring allowed a more precise definition of surgical trauma ranging from an initial full-thickness foveal tear, or induction of a cystoid macular edema (CME), until no foveal defect was discernible, as the technique improved. However, as the subretinal fluid wave detached the fovea, the aforementioned lesions formed, whereas persistent retinal adhesion reproducibly proved to remain in the distal parafoveal semi-annulus. Measures to reduce foveal trauma during submacular fluid injection included reducing intraocular pressure, injection volume, and velocity, as well as the retinal location for bleb initiation, use of a vitreous tamponade, and a dual-bore subretinal cannula. Conclusions: A stable very low intraocular pressure and careful subretinal injection may avoid tangential macular stretching or mechanical CME formation, while vitreous tamponade may facilitate a more lamellar subretinal flow, all thereby reducing foveal trauma during submacular injection in NHP. Translational Relevance: These results can be relevant to any submacular surgery procedure used today, as they synergistically reduce the risk of compromising foveal integrity. publishedVersion |
| Databáze: | OpenAIRE |
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