Careful handling of Tenon's capsule and conjunctiva key for Port Delivery System implant
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The Port Delivery System with ranibizumab is an innovative investigational drug delivery system from Genentech that requires meticulous handling of Tenon’s capsule and conjunctiva during the implantation procedure to ensure success.
“The most important thing for retinal surgeons approaching this surgery is the frame of mind going into the surgery. It needs to be closer to the glaucoma specialist, and going back to our training with glaucoma procedures, in terms of the meticulous and careful handling of Tenon’s and conjunctiva. Most pitfalls that came up through the trials involved the conjunctiva and Tenon’s,” Jonathan Jonisch, MD, said at the virtual OSN New York Retina meeting.
Conjunctiva and Tenon’s capsule dissection during peritomy and anchorage of both layers to the anterior limbus during closure are crucial for minimizing ocular adverse events and optimizing surgical outcomes, he said.
A spacious peritomy and careful blunt dissection of the conjunctiva on Tenon’s capsule from the limbus to the fornix in the area of the implant is important in the beginning of the procedure, he said.
“Ensure a wide dissection under Tenon’s posteriorly and laterally to minimize traction after closure. It is important to ensure the scleral incision is located away from the radial conjunctival incision to reduce the risk of implant exposure,” Jonisch said.
During closure, it is important to identify Tenon’s capsule under the conjunctiva and draw both layers to the anterior limbus. Anchoring both layers to the limbus with a true scleral bite, not an episcleral bite, by using several sutures is critical to maintain the integrity of healthy tissues over the implant flange, he said.
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Jonisch J. Retinal surgery. Presented at: OSN New York and OSN New York Retina; Oct. 17-18, 2020 (virtual meeting).
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