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Extra-ocular surgery for implantation of an active subretinal visual prosthesis with external connections: feasibility and outcome in seven patients
  1. Dorothea Besch (dorothea.besch{at}med.uni-tuebingen.de),
  2. Helmut Sachs (helmut.sachs{at}klinik.uni-regensburg.de),
  3. Peter Szurman (peter.szurman{at}med.uni-tuebingen.de),
  4. Dirk Gülicher (dirk.guelicher{at}med.uni-tuebingen.de),
  5. Robert Wilke, Dr. (roberwilke{at}aol.com),
  6. Siegmar Reinert (siegmar.reinert{at}uni-tuebingen.de),
  7. Eberhart Zrenner (ezrenner{at}uni-tuebingen.de),
  8. Karl Ulrich Bartz-Schmidt (u.bartzschmidt{at}googlemail.com),
  9. Florian Gekeler (gekeler{at}uni-tuebingen.de)
  1. Center for Ophthalmology, University of Tübingen, Germany
  2. University-Eye-Hospital, Regensburg, Germany
  3. Center for Ophthalmology, University of Tübingen, Germany
  4. Department of Oral and Maxillofacial Surgery, University of Tübingen, Germany
  5. Center for Ophthalmology, University of Tübingen, Germany
  6. Department of Oral and Maxillofacial Surgery, University of Tübingen, Germany
  7. Center for Ophthalmology, University of Tübingen, Germany
  8. Center for Ophthalmology, University of Tübingen, Germany
  9. Center for Ophthalmology, University of Tübingen, Germany

    Abstract

    Background: Due to low energy levels in microphotodiode based subretinal visual prostheses external power supply is mandatory. We report on the surgical feasibility and the functional outcome of the extra-ocular part of an approach to connect a subretinal prosthesis to an extra-corporeal connector in the retro-auricular space via a trans-scleral, trans-choroidal cable.

    Methods: Seven volunteers with retinitis pigmentosa received an active subretinal implant; energy was supplied by gold wires on a trans-sclerally, trans-choroidally implanted polyimide foil leading to the lateral orbital rim where it was fixated and connected to a silicone cable. The cable was implanted subperiostally beneath the temporal muscle using a trocar to the retro-auricular space where it penetrated the skin for connection to a stimulator. To avoid subretinal movement of the implant three tension relief points have been introduced.

    Results: All implantations were performed as planned without complications, no serious adverse events occurred in the post-operative period. Fixation of the implants was stable throughout the entire study duration of 4 weeks; permanent skin penetration proved to be uncomplicated. Motility was minimally restricted in downgaze and ab-/adduction. Explantation was uneventful.

    Conclusion: The above described procedure provides a method for stable fixation of a subretinal device with a trans-scleral, trans-choroidal cable connection to an extra-corporeal connector.

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