77 Works

Retinectomy as a Pressure Lowering Procedure

Bernd Kirchhof
The rational for a retinectomy in the context of refractive glaucoma is the fact that the retina is the main barrier for the transition of water from the vitreous cavity to the choroid. The advantage of a retinectomy in refractive glaucoma is, that a retinal hole cannot close/heal. Thus the IOP lowering effect lasts as long as the underlying choroidal sponge is perfused. Complications are PVR retinal detachment. That is why it is advisable to...

Exchange of multifocal IOL decentered in a fibrose capsular bag in the lens-IOL

Marie-José Tassignon
A case of an IOL exchange. It is a multifocal slightly tilted IOL. The patient was operated six years ago. When she was in the mean time operated on the other eye with a bag-in-the-lens toric correction, she saw the difference and wanted to have an exchange of this decentered lens. The quality of vision was otherwise not good enough for her dominant eye.

Illuminated Cutter plus Chandelier Light

Bernd Kirchhof
Vitreous to be demonstrated requires a focused light or a light source close to the cutter tip. A diffuse light pipe must be approached to the cutter tip. A chandelier light is diffuse and in most locations to distant from the cutter tip and unsuitable to visualize vitreous. The chandelier light provides the diffuse light for the overview (safety) and an additional light should be positioned close to the cutter opening. An illuminated cutter delivers...

Posterior Vitreous Separation using the Jet of a Flute Needle

Bernd Kirchhof
Triamcinolone does clearly demonstrate the hyaloid, but does not help to loosen the vitreo-retinal adhesion. A jet of water directed obliquely onto the surface of the retina finds its way through the hyaloid and is then deflected by the retinal surface into the vitreo-retinal interface unless the jet is too strong. Then it can perforate the retina. Such a jet of fluid is often just enough to lift off the hyaloid locally, allowing the cutter...

RPE and Choroid Translocation in massive submacular hemorrhage

Bernd Kirchhof
Usually when larger blood volumes are being removed from underneath the macula then the RPE goes with the blood. An RPE substitute is then required, either by macular translocation or by translocation of a free transplant of pigment epithelium and choroid. The latter is shown here.

RPE and Choroid Translocation in Anti-VEGF-Non-Responder

Bernd Kirchhof
Until present it is difficult to indentify an Anti-VEGF Non-Responder early enough for submacular surgery to be still worthwhile. In this case (typically) surgery was considered not before VA had dropped to 0,1. There was an absolute scotoma temporal to the central fixation (microperimetry). Otherwise the surgical technique is identical to the approach for exsudative AMD before the introduction of VEGF-Blockers: Vitrectomy Posterior vitreous separation (if not yet present) 360 degree laser cerclage Laser demarcation...

Low viscosity silicone oil as infusion fluid in massive subretinal hemorrhage

Bernd Kirchhof
Vitrectomy with BSS infusion in massive intraokular hemorrhage is very tiring, because of the impedment of sight from the swirling-up blood. Here a silicone oil of very low viscosity - like 20 cSt - replaces the BSS infusion, does not mix with blood and allows a rapid removal of the blood from within the eye.

CNV Adherent to Macula

Bernd Kirchhof
Especially in long standing CNV, like occult CNV, fibrotic PED the RPE-Choroid complex is eventually tightly adherent to the outer retina. In this older film an angulated subretinal forceps is being used as a spatula as well in order to sever off the CNV from the outer retina. Apparently here the connation is too strong. Thus during the subsequent pulling a macular hole is created. The strong adhesion is apparent from the indentation (navel) of...

Argus II-Epiret

Stanislao Rizzo
The epiretinal implant ARGUS II is placed on the macula in one patient with advanced retinitis pigmentosa to restore some form of visual acuity

Membrane on the back Side of the ILM Causing Pucker-like Distortions

Bernd Kirchhof
Even though the ILM stains homogenously the ILM is distorted like in a pucker. The explanation is that the causative membrane resides on the back side of the ILM and bridges to the retina, possibly glial tissue. Thus ILM is a substrate and precondition for membrane formation not matter on which side of the ILM membranes develop.

iLASIK using IntraLase iFS and Visx STAR S4

Prof. Dr. Michael C. Knorz
The video shows an iLASIK procedure performed with the IntraLase iFS femtosecond laser and the Visx STAR S4 excimer laser.

Low viscosity silicone oil as infusion fluid in vitreous hemorrhage

Bernd Kirchhof
In vitrectomy of massive vitreous hemorrhage the view is typically compromised by stirred blood. In order to speed up the procedure saline as infusion fluid is replaced by very low viscosity silicone oil. The silicone has the advantage not to mix with blood. At the same time all vitrectomy procedures can be performed as like under saline. The much improved view into the eye should shorten the procedure. In the end the silicone oil as...

Removal of heavy silicone oil from the posterior surface of the natural lens

Bernd Kirchhof
Apparently not only silicone but rarely also the natural lens provides a surface for strong adherence of silicone oil, in this case heavy silicone oil (Densiron®). The removal is possible by a solvent for silicone oil: F6H8 or F4H5, two semifluorinated fluorocarbons. The solvent plus the fluid jet manage to remove the oil form the surface of the natural lens.

Removal of Standard Silicone Oil, Influence of Type of Infusion Cannula

Bernd Kirchhof
Standard silicone oil being lighter than water can simply be removed by aspiration. The replacing water is usually entering the eye via an end-opening straight cannula. The jet of water directed towards the center of the eye often results in a central water filled cavity surrounded by an outer rim of silicone more or less adherent to the retina. Consequently the complete removal of oil is sometimes tedious and complicated. Alternatively an infusion cannula with...

Trabeculectomy Fornix Based

New York Eye And Ear Infirmary
Fornix based trabeculectomy with mitomycin C.

Iatrogenic Retinal Dialysis from instruments introduced through the sclerotomy

Bernd Kirchhof
Occasionally and usually unexpected the instrument (light pipe, cutter, forceps) introduced through the sclerotomy pushes forward condensed vitreous that is connected to the peripheral retina. The stress from the induced traction is usually sufficient to create a more or less large dialysis. Being aware of the risk, peripheral fundus inspection with indentation and eventual cryopexy or endolaser is the treatment of choice, not necessarily combined with a tamponade in otherwise attached retina.

Trabeculectomy Limbus Based

New York Eye And Ear Infirmary
Trabeculectomy Limbus Based, Mitomycin,

Macular Hole in Combination with Pucker

Bernd Kirchhof
Since the introduction of dyes in macular hole surgery we recognize the admixture of more or less epiretinal membrane in conjunction with macular hole formation. I do not imply a correlation of epimacular membranes to macular hole formation since even severe pucker formation occur without macular hole. Adressing those combined macular holes and epiretinal membranes we first need to peel the epiretinal membrane, which we find in the non-stained area. Thereafter we need to check...

Transplantation of a free RPE-choroid graft in patients with exudative AMD

Jan Van Meurs
82 year old female, 5 Avastin injections for a vascularized RPE detachment, submacular hemorrhage treated with vitrectomy/TPA/gas in the acute stage, revealing an RPE-tear with VA of 20/800. RPE transplantation in an effort to reconstitute the underlayer of the macula.

Pucker Membrane does not stain with ICG

Bernd Kirchhof
Even though this is a macular hole this film focuses on the staining characteristics of the accompanying pucker membrane extrafoveally. The epiretinal membrane stands out in negative contrast, as unstained. Once the pucker is peeled then a second application of ICG unreveals the remaining ILM.

Femtosecond Laser LASIK with the AMO FS 60 Femtosecond Laser

Prof. Dr. Michael C. Knorz
This video demonstrates a LASIK procedure with the AMO FS 60 femtosecond laser and the Visx STAR IR excimer laser.

Horseshoe tear at the End of Vitrectomy

Bernd Kirchhof
It is mandatory to inspect the peripheral retina at the end of vitrectomy of incidental retinal tears usually associated with the sclerotomies. These may be preformed or newly formed by incarceration of vitreous base into the sclerotomie during change of instruments.

Hamartoma of the optic disc and the retinal pigment epithelium

Bernd Kirchhof
A combined hamartoma of the optic disc and the RPE may show as a submacular CNV or/ and an epimacular gliosis. In this example the visual acuity is 20/200 and stable but metamorphopsia is a constant complaint. The surgical approach aims to release epiretinal traction via ILM peeling and thereby improve the metamorphopsia. No epiretinal tissue is found, since the ILM stains homogenously. A fibrous tuft is peeled from the optic disc. Since in angiography...

Laser Refractive Lens Surgery using an Intraocular Femtosecond Laser

Prof. Dr. Michael C. Knorz
This video shows an intraocular femtosecond laser (Alcon LenSx Lasers, Inc, Ft. Worth, TX, USA) used to perform laser refractive lens surgery. The laser uses build-in optical coherence tomography (OCT) to image the cornea, lens capsule and lens. Nucleus liquefaction, capsulorhexis and corneal incisions are then positioned on the screen, and the laser performs lens liquefaction followed by capsulorhexis and corneal incisions. Irrigation/aspiration only is used to remove the liquefied lens nucleus, and an intraocular...

Full Macular Translocation in Exsudative Age Related Macular Degeneration

Bernd Kirchhof
Core vitrectomy, posterior vitreous separation if not yet present, vitreous base shaving, usually those eye are pseudophakic otherwise the natural lens can be shifted anteriorly by anterior chamber drainage, so that the vitreous base is accessible without damage to the lens. BSS injection is used to detach the retina, first transretinally to create a retinal bleb of sufficient size to allow further BSS injection transretinally via a 30 or 27 gauge cannula. As long as...

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