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      Robotic Assisted Cannulation of Occluded Retinal Veins

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          Abstract

          Purpose

          To develop a methodology for cannulating porcine retinal venules using a robotic assistive arm after inducing a retinal vein occlusion using the photosensitizer rose bengal.

          Methodology

          Retinal vein occlusions proximal to the first vascular branch point were induced following intravenous injection of rose bengal by exposure to 532nm laser light delivered by slit-lamp or endolaser probe. Retinal veins were cannulated by positioning a glass catheter tip using a robotically controlled micromanipulator above venules with an outer diameter of 80μm or more and performing a preset piercing maneuver, controlled robotically. The ability of a balanced salt (BSS) solution to remove an occlusion by repeat distention of the retinal vein was also assessed.

          Results

          Cannulation using the preset piercing program was successful in 9 of 9 eyes. Piercing using the micromanipulator under manual control was successful in only 24 of 52 attempts, with several attempts leading to double piercing. The best location for cannulation was directly proximal to the occlusion. Infusion of BSS did not result in the resolution of the occlusion.

          Conclusion

          Cannulation of venules using a robotic microassistive arm can be achieved with consistency, provided the piercing is robotically driven. The model appears robust enough to allow testing of therapeutic strategies aimed at eliminating a retinal vein thrombus and its evolution over time.

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          Most cited references31

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          • Article: not found

          Predictors of anti-VEGF treatment response in neovascular age-related macular degeneration.

          Currently available evidence on predictors of anti-vascular endothelial growth factor (VEGF) treatment response in neovascular age-related macular degeneration was reviewed. No meta-analysis of results is possible because of a lack of controlled and randomized trials, varying treatment regimes and outcome measures used, as well as suboptimal reporting. For genetic factors, most evidence to date has been generated for single nucleotide polymorphisms (SNPs) in the complement factor H (CFH), and VEGF-A genes. Just under half of the SNPs assessed in the CFH gene and 15% of the SNPs assessed in the VEGF gene were found to be associated with visual outcomes or the number of injections required during follow-up. Some evidence suggests association of worse treatment outcomes as well as a younger age at treatment onset with an increasing number of risk alleles in known risk genes (CFH and ARMS2/HTRA1) and polymorphisms in the VEGF-A gene. Clinical factors such as higher age, a better visual acuity (VA), a larger choroidal neovascularization (CNV) lesion at baseline, and a delay between symptom onset and initiation of treatment of more than 3 weeks also impact outcomes. Conversely, a worse acuity at baseline predicted more gain in vision. Overall, patients presenting with good acuity at baseline were more likely to have good VA at follow up, but the gain afforded by treatment was impacted by a ceiling effect. Most available evidence suggests a strong association of clinical factors such as age, baseline VA, and CNV lesion size with anti-VEGF treatment outcomes. No behavioral factors such as smoking influence treatment outcomes. Based on the studies conducted so far, the evidence suggests that underlying genotype of known AMD risk associated genes or of the VEGF-A gene have a limited effect, whereas presenting clinical factors appear to be more important in determining treatment outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.
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            • Record: found
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            Histopathologic study of nine branch retinal vein occlusions.

            Occlusions of nine branch retinal veins in eight eyes of seven patients were studied histopathologically by serial sections through the affected areas. Intravitreal neovascularization from the disc, retina, or both was noted in four eyes. Two additional eyes had intraretinal neovascularization (intraretinal microvascular abnormalities). Cystoid macular edema was present in five eyes. A fresh or recanalized thrombus was noted at the site of vein occlusion in all eyes. Inner ischemic atrophy of the retina was found distal to the area of occlusion in six of the nine affected quadrants of the eight eyes. Although the corresponding branch retinal arteries showed varying degrees of sclerosis (severe, three eyes; moderate, five eyes; and minimal, one eye), no definite thrombus was observed in any of them.
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              • Record: found
              • Abstract: found
              • Article: not found

              Ranibizumab in preproliferative (ischemic) central retinal vein occlusion: the rubeosis anti-VEGF (RAVE) trial.

              To analyze the efficacy and safety of ranibizumab in eyes with preproliferative (ischemic) central retinal vein occlusion.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                27 September 2016
                2016
                : 11
                : 9
                : e0162037
                Affiliations
                [1 ]MicroInvasive Ocular Surgery Center (MIOS sa), Lausanne, Switzerland
                [2 ]Preceyes nv, Einhoven, The Netherlands
                [3 ]ThromboGenics nv, Leuven, Belgium
                [4 ]Medanex Clinic BVBA, Diest, Belgium
                [5 ]Crystapharm BVBA, Lubbeek, Belgium
                University of Tennessee, UNITED STATES
                Author notes

                Competing Interests: MDdS received grant support from TG and is a patent holder (without royalty) of ocriplasmin. He is also a founding member and chief medical officer of Preceyes NV.

                • Conceived and designed the experiments: MDdS BJ JMS.

                • Performed the experiments: MDdS TJ VV CM MJB TCMM.

                • Analyzed the data: BJ MDdS GJLN TCMM MJB.

                • Contributed reagents/materials/analysis tools: BJ.

                • Wrote the paper: MDdS BJ TCMM GJLN.

                Author information
                http://orcid.org/0000-0002-9217-5603
                Article
                PONE-D-16-09607
                10.1371/journal.pone.0162037
                5046264
                27676261
                58940720-ccbe-47aa-b5e7-83d59af2eafa
                © 2016 de Smet et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 6 March 2016
                : 13 July 2016
                Page count
                Figures: 9, Tables: 0, Pages: 16
                Funding
                The study was funded by Thrombogenics nv. The funder contributed to the study design, but did not influence the decision to publish or contribute substantially to the preparation of the manuscript.
                Categories
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                Biology and Life Sciences
                Anatomy
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                Eyes
                Medicine and Health Sciences
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                Head
                Eyes
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                Eyes
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