Singapore National Eye Centre, Singapore, Singapore.
Singapore Eye Research Institute, Singapore, Singapore.
Transl Vis Sci Technol. 2021 Jan 7;10(1):10. doi: 10.1167/tvst.10.1.10. eCollection 2021 Jan.
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.
Sixteen eyes of 13 healthy macaques underwent a 25-gauge vitrectomy and subretinal injection of balanced salt solution monitored by microscope-integrated intraoperative optical coherence tomography (miOCT). The animals were followed with OCT and histology.
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.
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.
These results can be relevant to any submacular surgery procedure used today, as they synergistically reduce the risk of compromising foveal integrity.
将高级治疗性药物产品递送至黄斑下腔的方法正在逐渐演变为一种治疗方式。用于年龄相关性黄斑变性（AMD）的细胞替代疗法和用于 RPE65 的基因疗法是最近成功的例子。在此，使用非人类灵长类动物（NHP）模型来研究分离黄斑的手术方法。
13 只健康恒河猴的 16 只眼接受了 25G 玻璃体切割术和显微镜集成术中光学相干断层扫描（miOCT）监测下的视网膜下注射平衡盐溶液。通过 OCT 和组织学对动物进行了随访。
miOCT 监测可更精确地定义手术创伤，范围从最初的全层黄斑裂孔或诱导形成囊样黄斑水肿（CME），直到无法识别黄斑缺损，因为技术在不断改进。然而，随着视网膜下液波分离黄斑，上述病变形成，而持续的视网膜粘连可重现地证明仍保留在远旁中心半环。减少黄斑下腔液注射中黄斑创伤的措施包括降低眼内压、注射量和速度，以及起始部位的视网膜位置、使用玻璃体填塞和双孔视网膜下套管。
稳定的非常低的眼内压和仔细的视网膜下注射可以避免切线性黄斑拉伸或机械性 CME 形成，而玻璃体填塞可能会促进更层状的视网膜下液流，从而减少 NHP 中黄斑下注射时的黄斑创伤。
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