77 Works

Removal of a hemorrhagic hyaloid strongly attached

SDOFTALMOLOGIA.COM.BR
A accidental puncture for cataract surgery anesthesia caused a dense vitrous hemorrhage, the hyaloid of this 40y old male was very dificult to remove. We performed a viscodissection of the hyaloyd using a Flynn´s cannula

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.

No ILM present in a case of PVR

Bernd Kirchhof
The intention to peel the ILM over the macula was to prevent Pucker formation later on in a case of PVR. Suprisingly there was not staining for ILM with ICG, and no tissue typical for ILM could be peeled off. Instead the consistency of the tissue was that of glial tissue or nerve fibre layer. Apparently it is possible that ILM is not developed at all.

Normal Posterior Vitreous Separation by Cutter Aspiration

Bernd Kirchhof
Usually posterior vitreous aspiration can be achieved by moving the cutter close to the attached retina and maximal suction near the disc or over the temporal vascular arcade. Successful PVD can be recognized by the migrating borderline between attached and detached hyaloid, moving from the posterior pole to the periphery in synchrony with the tip of the cutter.

Posterior Vitreous Separation by a Combination of Triamcinolon and Fluid Jet

Bernd Kirchhof
The advantage of triamcinolone in the context of the creation of posterior vitreous separation is to better visualize the hyaloid. Being able to directly see the hyaloid may help to improve the effectiveness of detaching the hyaloid via the cutter and helps to realize a beginning separation. But triamcinolone does not directly interfere with vitreo-retinal adhesion. A jet of fluid, BSS, applied through a small glass capillary pipette however can sever and weaken vitreo-retinal adhesions...

Vitrectomy and Lentectomy in FEVR

Bernd Kirchhof
The goal of treatment of such advances stages of FEVR is to get to the abnormal peripheral retinal vessels and coagulate them. On the way lensectomy and vitrectomy are necessary. The vitreous consists for typical multiple onion-like layers of veils, that are rather stiff, but not very tractional and grow out of the retina. They cannot be completely detached but only trimmed back.

Silicone oil bubbles entrapped in the vitreous base during silicone oil removal

Bernd Kirchhof
Especially heavy silicone oil has the peculiarity to be retained and entangled into the vitreous base. Thus after aspiration of the core of heavy oil it is strongly recommended to inspect the vitreous base with indentation. Since the oil bubbles are entrapped in the vitreous it requires active suction and cutting with a vitrectomy probe.

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...

Optic Disc Pit treated by Vitrectomy and Platelet Concentrate

Bernd Kirchhof
After unsuccessful pretreatment with laser along the temporal circumference of the optic disc (old scars) a vitrectomy is performed, posterior vitreous separation and platelet concentrate. The idea of platelets is to clog the pig. The idea of vitrectomy is to release traction of eventual vitreous strands into the pit. Both rationales are hypothetical.

PVR in the Superior Retinal Periphery after Tamponade by Heavy Silicone oil

Bernd Kirchhof
This eye originally had PVR retinal detachment in the inferior retinal periphery. It was at first treated by vitrectomy, retinectomy and standard silicone oil. After PVR recurrence under standard silicone oil typically in the inferior peripheral retina, heavy silicone oil was filled at the occasion of re-vitrectomy. The Film shows the end of the removal of heavy silicone oil and a partially detached retina, but this time in the superior retinal periphery. The vitreous base...

Posterior Vitreous Separation by Tano Scraper

Bernd Kirchhof
There are few instances when either triamcinolone or fluid jet are insufficient to help detach the hyaloid. This is my only indication in vitreo-retinal surgery to use a Tano scraper. Its rough and sticky “tongue” entangles with the collagen fibres of the hyaloid and can provide the starting edge for the cutter.

Intraocular foreign body in the lens

Ilian Shandurkov
Technique for atraumatic viscoexpression of intaocular foreign body affecting the lens is demonstrated in a short video.

Subchoroidal Infusion with Air, Water, Silicone oil

Bernd Kirchhof
The typical situation for subchoroidal infusion is ocular hypotony. In the first instance hypotony exists because an infusion in place is removed and another infusion is introduced through the same sclerotomy. The line contains air which instantly escapes through the adjacent sclerotomy for the light pipe. An angulated spatula is used from the opposite site of the infusion to free the tip of the subchoroidal infusion cannula from ciliary body tissue. Eventual remaining subchoroidal air...

Vitrectomy and Lentectomy in Childhood Uveitis

Bernd Kirchhof
The vitrectomy approach is explorative, because the condition of the retina and optic disc could not be estimated preoperatively through the dense cataract. IOP was low –normal. Since the view to the fundus was at first obscured the lens was removed via a limbal approach by a vitreous cutter. Then a common three port vitrectomy approach was possible showing a fibrotic ciliary body and peripheral retina as a consequence of long standing intermediate uveitis. The...

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.

Trabeculectomy Limbus Based

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

Foreign Body Removal by Vitrectomy and Endomagnet

Bernd Kirchhof
This is an encapsulated older intraocular foreign body. At the time of injury there was very little vitreous hemorrhage. It was then possible to put a laser barrage around the foreign body to be able to remove the foreign body later on and lower risk of inducing a retinal detachment. Once the capsule is opened by the vitreous cutter the endomagnet attracts the iron foreign body and allows to remove it from the eye via...

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.

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.

Simulated missing of ILM in Uveitis asssociated macular edema with overlooked hyaloid attached

Bernd Kirchhof
Initially, I was uncertain whether there was ILM at all, since ICG staining did not stain at all, not the posterior pole, not the ILM outside the posterior pole. Only after more or less blind peeling a preretinal sheet unraveled, that turned out be attached thick changed hyaloid, preventing the staining of the ILM. After posterior vitreous separation staining of the ILM was possible as usual. The reason for a completely negative ILM staining may...

Scleral loop to fixate an encircling band

Bernd Kirchhof
The standard fixation of an encircling belt is a permanent scleral suture. Sutures have the disadvantage that they eventually may protrude through the conjunctiva, they may cut through the sclera causing dislocation of the belt, or they may be assciated with infections. The scleral loop requires only a round knife (Teller-Messer), formed like a plate. In case of very thin (blue) sclera a suture will not hold and extra sclera need to be sutured onto...

Implantation of a Flexible Silicone Iris Diaphragm to Prevent Silicone Keratopathy

Bernd Kirchhof
Indications for a closed iris diaphragm are eye that require a permanent (PVR, aqueous insufficiency) silicone oil tamponade, but are at risk of silicone keratopathy (Aniridia, Aphakia). A former version with a central opening is no longer used, because all indications can be served with the closed flexible type.

Revisonal surgery

Bernd Kirchhof
About six months after implantation the footplate of the epiretinal implant rotated due to twist in the cable. This lead to a loss of contact with the retina. The pin holding the footplate needed to be removed. Finally also the sclerotomy needed to be reopened to abolish the twist in the cable. Unfortunately I pushed the pin through the footplate two times requiring removal of the pin and the spring separately from within the eye.

Canaloplasty for OPen Angle Glaucoma

Thomas Theelen, MD, PhD
This video shows our straightforward appraoch for canaloplasty (Department of Ophthalmology, Radboud University Medical Centre, Nijmegen, NL)

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...

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