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Long-term Observation after Implantation of Epiretinal Structures
Gerding H.,
Westfälische Wilhelms-Universität Münster, Augenklinik (Münster)
Background: It is an essential challenge of the Retina Implant Project to provide techniques for a precise and permanent mechanical stabilization of implant structures in epiretinal position. Different techniques (tacks, biological sealing) that may be potentially useful for the stabilization of implants were examined.
Methods: Implantation and stabilization of electrically inactive structures directly in contact with the inner retinal surface after plasmin-assisted vitrectomy. Mechanical stabilization by: 1. two component fibrin sealing with electrochemical binding (ELCH) to the ILM, 2. control experiments without ELCH, 3. control experiment +ELCH without Thrombin, 4. sealing with mussel adhesive protein (MAP), 5. stabilization by conventional retinal tacks (Heimann type), 6. stabilization by newly designed hybride microfixateurs. Postoperative long-term follow-up by funduscopy, photography, electrophysiological examinations and finally histology covering a period of 4.5-18 months.
Results: Permanent mechanical stabilization of implants was achieved in setup #1, #5, and #6 covering the whole follow-up period. Modifications #2, #3, #4 was complicated by early postoperative implant dislocation in all cases. Mechanical insertion of conventional tacks revealed to be rather traumatic yielding unpredictable results. The new type of hybride microfixateurs was much less traumatic and easier to handle.
Conclusions: Epiretinal placement and fixation of implants by the use of microfixateurs and biological sealing with ELCH results in a precise and constant mechanical fixation of epiretinal implants. Long-term observations clearly demonstrate the functional and morphological integrity of the retina close to and underneath implanted structures.