PEELS. PIGMENT EPITHELIUM ENDOSCOPIC LASER SURGERY IN AMD

Frank H. J. Koch, L. O. Hattenbach, B. Kacer, A. Augustin, P. Luloh, H. Quiroz-Mercado (Frankfurt/M.)

Objective: To develop a new concept and technique for subretinal surgery which overcomes the difficulties of current concepts.

Methods: Subretinal pigment epithelium endoscopic laser surgery (PEELS) has been performed on 13 predominantly occult and two classic choroidal neovascular membranes using the GRIN endoscope. Surgical techniques includes pars plana vitrectomy, preliminary iatrogenic detachment of the posterior pole, transretinal endoscopic laser coagulation of CNV, and intraoperative reattachment of the retina. The procedure lasts about 45 - 90min.

Results: Endoscopic subretinal surgery via a small retinotomy allows optical controlled subfoveal lasercoagulation without thermal damage of the foveal sensory retina. Adequate positioning and preparation of the retinotomy and stabilisation of the subretinal cavity are essential. Therfore, either viscous substances or heavy liquids have to be injected subretinally. In 12 out of 15 patients we could achieve at least stabilisation of vision over a follow up period of 3 to 12 months. One patient developed an intraoperative bleeding which could not be removed and did organize itself postoperatively, one patient did develop a mild PVR peripheral to the retinotomy site which was successfully treated in a second intervention. Six of our patients did improve vision.

Conclusion: The careful treatment of the retinotomy and selection of laser energy for coagulation behind the retina seem to be of major importance for the anatomical and functional success of the PEELS procedure. The potentials of pigment epithelium migrations / regeneration are under examination.


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