title: Extraocular Surgical Approach for Placement of Subretinal Implants in Blind Patients: Lessons from Cochlear-Implants.
abstract: In hereditary retinal diseases photoreceptors progressively degenerate, often causing blindness without therapy being available. Newly developed subretinal implants can substitute functions of photoreceptors. Retina implant extraocular surgical technique relies strongly on cochlear-implant know-how. However, a completely new surgical approach providing safe handling of the photosensor array had to be developed. The Retina Implant Alpha IMS consisting of a subretinal microphotodiode array and cable linked to a cochlear-implant-like ceramic housing was introduced via a retroauricular incision through a subperiosteal tunnel above the zygoma into the orbit using a specially designed trocar. Implant housing was fixed in a bony bed within a tight subperiosteal pocket in all patients. Primary outcomes were patient short term safety as well as effectiveness. Nine patients participated in the first part of the multicenter trial and received the subretinal visual implant in one eye. In all cases microphotodiode array pull-through procedure and stable positioning were possible without affecting the device function. No intraoperative complications were encountered. The minimally invasive suprazygomatic tunneling technique for the sensor unit as well as a subperiosteal pocket fixation of the implant housing provides a safe extraocular implantation approach of a subretinal device with a transcutaneous extracorporeal power supply.
authors.affiliation: Klinikum Stuttgart-Olgahospital, ORL-Department, Pediatric Otorhinolaryngology and Otology, Kriegsbergstraße 62, 70176 Stuttgart, Germany.
authors.forename: Assen
authors.initials: A
authors.lastname: Koitschev
authors.affiliation: Center for Ophthalmology, University of Tübingen, Schleichstraße 12-16, 72076 Tübingen, Germany.
authors.forename: Katarina
authors.initials: K
authors.lastname: Stingl
authors.affiliation: Center for Ophthalmology, University of Tübingen, Schleichstraße 12-16, 72076 Tübingen, Germany.
authors.forename: Karl Ulrich
authors.initials: KU
authors.lastname: Bartz-Schmidt
authors.affiliation: Retina Implant AG, Gerhard-Kindler-Straße 8, 72770 Reutlingen, Germany.
authors.forename: Angelika
authors.initials: A
authors.lastname: Braun
authors.affiliation: Center for Ophthalmology, University of Tübingen, Schleichstraße 12-16, 72076 Tübingen, Germany; Klinikum Stuttgart-Katharinenhospital, Eye Clinic, Kriegsbergstraße 60, 70174 Stuttgart, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Gekeler
authors.affiliation: Retina Implant AG, Gerhard-Kindler-Straße 8, 72770 Reutlingen, Germany.
authors.forename: Udo
authors.initials: U
authors.lastname: Greppmaier
authors.affiliation: Klinikum Dresden Friedrichstadt, University Teaching Hospital, Eye Clinic, Friedrichstraße 41, 01067 Dresden, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Sachs
authors.affiliation: STZ Eyetrial, Center for Ophthalmology, University of Tübingen, Schleichstraße 12-16, 72076 Tübingen, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Peters
authors.affiliation: STZ Eyetrial, Center for Ophthalmology, University of Tübingen, Schleichstraße 12-16, 72076 Tübingen, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Wilhelm
authors.affiliation: Center for Ophthalmology, University of Tübingen, Schleichstraße 12-16, 72076 Tübingen, Germany; Werner Reichardt Centre for Integrative Neuroscience (CIN), Otfried-Müller-Straße 25, 72076 Tübingen, Germany.
authors.forename: Eberhart
authors.initials: E
authors.lastname: Zrenner
authors.affiliation: Center for Ophthalmology, University of Tübingen, Schleichstraße 12-16, 72076 Tübingen, Germany.
authors.forename: Dorothea
authors.initials: D
authors.lastname: Besch