Surgical Implantation of Revakinagene Taroretcellwey for the Treatment of Macular Telangiectasia Type 2: Technique and Surgical Pearls.

Abstract

Macular telangiectasia type 2 (MacTel), a bilateral, neurodegenerative disease associated with photoreceptor loss, often leads to progressive scotomas, metamorphopsia, and impaired reading function. Revakinagene taroretcel-lwey, a Food and Drug Administration (FDA)-approved encapsulated cell-based therapy for adults with MacTel, is surgically inserted into the vitreous cavity and provides sustained intraocular delivery of recombinant human ciliary neurotrophic factor (CNTF). Results from two phase 3 randomized clinical trials support the efficacy and safety of revakinagene taroretcel-lwey; explant analyses have demonstrated bioactive CNTF release up to 14.5 years. This report summarizes the surgical procedure and techniques for revakinagene taroretcel-lwey implantation, including implant preparation, insertion, wound closure, and postoperative procedures, and highlights scenarios where expert guidance may help to prevent intraoperative errors and minimize the potential for postsurgical adverse events. Standardizing surgical steps and incorporating expert guidance into surgical technique may reduce adverse events, including migration and extrusion, wound leaks, and infections, supporting safe long-term CNTF delivery for treatment of MacTel.