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• W1536671517 abstract "Editor, Since the first electrical stimulation of the retina in blind patients (Humayun et al. 1996), retinal prostheses to restore vision have been developed. We previously reported about a new surgical method for fixation of epiretinal implants (Ivastinovic et al. 2009). The surgical procedure included combined vitrectomy and lensectomy, retinal tack insertion at the posterior pole followed by introduction of the implant through a 5 mm sclerotomy. The implant was then positioned onto the retinal tack and fixed with a silicone tube. This method provides a sufficiently firm fixation of the implant and additionally allows an atraumatic explantation, as an option for exchange for prostheses of newer generations. However, proliferative vitreoretinopathy (PVR) was observed in all eyes (n = 11), causing retinal detachment (RD) in 4 of 11 eyes. Lensectomy is known to induce PVR in porcine eyes (Mahmoud et al. 2003) but other potential stimuli, such as the retinal tack or the large sclerotomy, might also have contributed to the occurrence of PVR. So far, there are no reports about the tolerance of porcine eyes to retinal tacks and large sclerotomies lead to excessive PVR in rabbits’ eyes (Velikay et al. 1994). Therefore, we performed an experimental study to evaluate to which extent these two factors induce PVR in vitrectomized but not lensectomized porcine eyes. We performed an experimental animal study in nine domestic pigs weighting 20–25 kg. This animal trial was approved by Austrian legal authorities and the Medical University of Graz. The animals were treated according to guidelines of the Association for Research in Vision and Ophthalmology. Surgeries were performed under sterile conditions in general anaesthesia. All animals underwent vitrectomy using standard surgical parameters. Special care was taken to remove as much vitreous as possible. In group 1 (n = 5), the retinal tack was inserted at the posterior pole above the upper vessel arcade (Fig. 1A). In group 2 (n = 4), a limbus-based scleral flap was prepared on the upper temporal globe followed by introduction of the shortened implant dummy into the vitreous cavity through a 5 mm pars plana sclerotomy (Fig. 1B). The end of the shortened implant extended approximately 2 mm intraocularly. The extraocular part of the implant was sutured to the sclera. The implant was shortened to avoid intraocular fixation. After the observation period of 4 weeks, the eyes were clinically examined in general anaesthesia and enucleated after a painless euthanization. The globes were fixed and prepared for histological and immunohistochemical examination. (A) Insertion of the titanium retinal tack with the retinal forceps (both Geuder GmbH, Germany). (B) Shortened flexible polyimide strip of the retinal implant dummy (Intelligent Medical Implants GmbH, Germany) at the sclerotomy site. In group 1, the retina remained clinically intact. Histological examinations revealed thickening of the inner plexiform layer around the retinal tack (Fig. 1A). Immunohistochemistry disclosed accumulation of glial fibrillary acidic protein (GFAP) as a marker for glial scar tissue (Fig. 2B). In group 2, in three of four eyes, no pathological changes were observed whereas in one eye vitreous strands were found (Fig. 3A). After fixation of this globe, we noted perforation of the lens capsule by the shortened implant, which unintentionally occurred during the follow-up. The extent of GFAP accumulation was far less than in group 1 (Fig. 3B) and corresponded to GFAP accumulation commonly observed after vitreous surgery (Yoshida et al. 1993). (A) The thickening of the inner plexiform layer in the area surrounding the retinal tack (arrowhead). Van Gieson staining did not identify collagen fibres. (B) Excessive accumulation of glial fibrillary acidic protein (GFAP) in the corresponding area (arrowhead). [Retinal tacks were removed from the posterior pole before embedding the globe in paraffin. The samples were stained with haematoxylin-eosin and van Gieson (A). Glial tissue was detected with GFAP antibodies (B). Bars measure 100 μm]. (A) Vitreous strands extending from the perforation site of the lens capsule to the posterior pole causing traction. [The eyes were fixed with Davidson solution (glacial acetic acid, 95% ethyl alcohol, 10% neutral buffered formalin, distilled water, mixed in the relation 1:3:2:3). Before embedding in paraffin, the globes were placed in ethanol (70%, 90% and 100% for 1 day each)]. (B) Slight GFAP accumulation in the midperiphery after vitrectomy alone (arrowhead). Lensectomy reliably induces PVR in porcine eyes (Mahmoud et al. 2003; Ivastinovic et al. 2009). Its occurrence in our study in only one eye with the unintentional perforation of the lens capsule confirms previous observations. Large sclerotomies did not induce PVR despite of the polyimide strip placement at the sclerotomy site serving as scaffold. Retinal tacks induce GFAP accumulation, which might not be an issue as the area around the retinal tack is not destined to be stimulated with the epiretinal implant. In general, young pigs are more reactive than elderly humans. This fact explains the absence of PVR in patients receiving the same surgical procedure. Prior to epiretinal prosthesis implantation, an encircling laser photocoagulation is performed, which additionally minimizes the risk of RD." @default.
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• W1536671517 date "2010-10-26" @default.
• W1536671517 modified "2023-09-23" @default.
• W1536671517 title "Tolerance of porcine eyes to epiretinal prostheses implantation" @default.
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• W1536671517 doi "https://doi.org/10.1111/j.1755-3768.2010.01948.x" @default.
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