Skip to main content

Table 1 Surgical phases of the Limoli retinal restoration technique (LRRT)

From: Mesenchymal stem and non-stem cell surgery, rescue, and regeneration in glaucomatous optic neuropathy

• Anchoring of the sclera with 6-0 silk suture, near the inferior-temporal limbus, and globe deviated to the superonasal quadrant.
• Opening of the sub-conjunctival and sub-Tenon’s space at 11 mm from the inferior-temporal limbus, using 5.5″ Westcott Tenotomy curved scissors.
• Insert the Limoli-Basile conjunctival retractor in the space to make a scleral surgical field.
• To pre-cut the flap on the side in the sclera at 8 mm from the limbus using a 5-mm crescent knife angled up with the flap hinge always radial and to the left of the surgeon.
• Open a deep scleral flap of about 5 × 5 mm at the inferotemporal quadrant, maintaining the radial hinge. The sclerectomy has to be deep enough to allow viewing of the color of the choroid.
• Remove a little operculum in the distal part of the flap in order to facilitate blood circulation in the subsequent suprachoroidal autograft.
• Extract the orbital fat with forceps from a gap above the inferior oblique muscle. The fat must sufficiently be vascularized to allow it to survive after its implantation.
• Place the autologous fat flap on the choroidal bed and suture with choroidal 6/0 polyglactin fiber at the proximal edge of the door.
• Suture the scleral flap to avoid compression on the fat pedicle or its nutrient vessels.
• Infiltrate the stroma of the fat pedicle with 1 mL of PRP gel (obtained by centrifugation of the blood material, separation of the component, and platelet degranulation) using a 30-G angled (30°) cannula.
• Remove the conjunctival retractor. Suture the conjunctiva with 6/0 polyglactin fiber.
• Leave a small flexible plastic tube to insert the autologous ADSCs in the space between the flap, the choroid, and the suprachoroidal autograft, before closing.
• Fill the remaining space between the autologous fat graft, choroid, and scleral flaps with 0.5 cc of ADSCs in SVF and 0.5 of PRP using a 25-G cannula and close the suture.
• After surgery, administer 3 days of antibiotic therapy with 500 mg of azithromycin. Also, provide eye drop therapy with an antibiotic and steroid combination, such as chloramphenicol and betamethasone, for about 15–20 days.