Editors' Choice
    Retina/Vitreous, Vitreoretinal Surgery

    In this clinical video, Drs. Ninel Gregori and Janet Davis share their protocol for OCT-assisted delivery of voretigene neparvovec-rzyl (Luxturna) to patients with confirmed biallelic RPE65 mutations. Developed during gene therapy trials at Bascom Palmer, their protocol uses microscope-integrated intraoperative OCT to create a small pre-bleb before viral injection to avoid sub-RPE or suprachorodial injection. First, they stain and remove the hyaloid using a finesse loop and elevate it with a soft silicone tip. A balanced salt solution is then injected into the subretinal space and an OCT scan is done to check for foveal thinning. Once the bleb is made, voretigene is introduced using a 25-gauge no-duel bore cannula. The fovea, they explain, must be carefully monitored thereafter to avoid excessive stretching and macular hole formation. Scleral indentation can be used to rule out peripheral breaks. Finally, an air-fluid exchange is used to clear the virus. Drs. Gregori and Davis emphasize that different mutations can present very differently in patients, sometimes making vitreous elevation and bleb expansion difficult to predict. 

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