77 Works

Removal of retinal fold after primary vitrectomy

Bernd Kirchhof
The retinal fold crossed the macula and was a residuum of retinal detachment surgery with vitrectomy and gas tamponade. The video shows the flattening of the fold across the macula via vitrectomy approach, submacular fluid injection and retinal massage from a manipulator.

Cataract surgery with penetrating keratoplasty after anterior lamellar dissection

Non
We introduce a new technique that after anterior stromal dissection, cataract surgery is performed with clear vision, and then, the posterior stroma isremoved and penetrating keratoplasty is completed for an eye that had penetrating keratoplasty and cataract surgery planned. Partial thickness corneal incision was done with a Hessburg-Barron trephine. From the corneal incision, anterior stroma dissection was performed with an angled crescent blade. When the dissection was over, the anterior stroma was excised with a...

Posterior Vitreous Separation in Rhegmatogenous Retinal Detachment Complicated by Iatrogenic Retinal

Bernd Kirchhof
The combination of retinal detachment and adherent hyaloid is a situation a risk of iatrogenic retinal holes. The retina is mobile and aspiration of cortex cannot be separated from aspiration of retina. The cutter is apparently not a suitable instrument here. Two iatrogenic retinal holes occurred until the procedure was completed in a primary vitrectomy approach. Posterior vitreous separation is left for an eventual secondary procedure possibly in conjunction then with PVR surgery.

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...

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...

Primary Vitrectomy

Bernd Kirchhof
Primary vitrectomy has largely replaced bucking procedures because the procedure requires less experience, is more controlled and the retina is attached at the end of the intervention. The steps are as follows. Three port vitrectomy access, core vitrectomy, liquid perfluorocarbon, vitreous base shaving, eventually removal of the flap of the horseshoe tear, PFCL and BSS exchange against air to release subretinal fluid through the retinal hole, laser-or kryo-retinopexy around the hole and eventually 360 retinotomy,...

Endoscopy Assisted Argus II Epiretinal Prosthesis Implantation

SSMP
Endoscopy Assisted Argus II Epiretinal Prosthesis Implantation Surgical Video Recording done by Prof. Emin Ozmert, in Ankara University Vehbi Koç Eye Hospital, Ankara - TURKEY. By using endoscopic imaging during Argus II Retinal Implant surgery, it's easier to see that the ciliar body isn't damaged due to scleratomy as well as the retinal tack is in place and the spring is squeezed properly.

Endoresection of Choroidal Melanoma

Bernd Kirchhof
The reason for the endoresection is the location of the tumor in the vicinity of the macula. Brachytherapy as only means would likely damage the fovea. Endoresection is always combined with brachytherapy, but after removal of the tumor a much lower dose is needed to “sterilize” the sclera. The vitrectomy after 180 degree retinotomy is performed under air to prevent seeding of tumor cells. Also eventual hemorrhage does not compromise the view. The disadvantage of...

aniridia aphakia implant and corneal transplant surgery

Dr. Barbara Parolini Carbognin
the patient had undergone perforating trauma with loss of corneal tissue, aniridia aphakia and retinal detachment. the first surgery was performed to repair retinal detachment and to perform the first corneal transplant, with a gain in vision to 0,1 Snellen acuity pinhole. the corneal graft failed after silicone oil removal. one further surgery (Video) was planned to replace the corneal graft and to reconstruct the anterior segment with an aniridia aphakia implant.

Iatrogenic transfoveal submacular injection of liquid perfluorocarbon

Bernd Kirchhof
The overly hard fluid jet of liquid perfluorocarbon directed towards the posterior pole of the eye near the retinal surface perforates the fovea. Most of the subretinal fluid escapes spontaneously via a pre-existing retinotomy. Remnants of submacular PFCL are being evacuated by the pressure of a preretinal PFCL bubble and subretinal aspiration. The procedure is completed by submacular transplantation of autologous pigment epithelium and choroid. The iatrogenic macular hole is addressed by ILM peeling.

Persistent Hyaloid, posterior variant addressed by vitrectomy

Bernd Kirchhof
A prominent pucker-like formation in a child is diagnosed as posterior variant of primary persistent hyaloid. After vitrectomy a thick membrane can be aspirated and peeled of the macula with the cutter. Petechial hemorrhages suggest the ILM is gone with the epimacular membrane, which is confirmed by ICG staining. At the outer prominent rim of this process no further tissue can be peeled off.

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.

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...

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...

Removal of silicone oil from a silicone intraocular lens

Bernd Kirchhof
Although F6H8, a semifluorinated fluorocarbon, is a solvent for silicone oil, the solvent is not powerful enough to dissolve the oil and clean the lens simply by contact. It requires the force of a fluid jet to detach the oil form the surface of the silicone lens. This is the first time, that silicone oil can be removed from silicone intraocular lenses, avoiding the lens exchange. However a complete removal of remnants of silicone oil...

The bell pepper experiment: a novel self-sealing “screwcut” incision for sutureless vitrectomy

LO Hattenbach
Flattened sclerotomies are an essential step in ensuring postoperative wound stability in transconjunctival sutureless vitrectomy. However, in complex cases involving complete vitrectomy with shaving of the vitreous base, laser application and peeling of surface membranes, conventional angled incisions often leak at the end of the procedure. Here, we present a novel curved and twisted (screw-like=“screwcut“) self-sealing incision technique using a 23-gauge one-step microcannula array with sharp solid trocar blades. Based on a simple kitchen experiment,...

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...

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.

Sub-ILM Deposits of Silicone Oil Bubbles complication vitrectomy in Optic Pit

Bernd Kirchhof
The surgeon who performed the vitrectomy and silicone oil fill and silicone oil removal in optic pit was uncertain whether the central silicone oil bubbles were under the retina. Subretinal oil has been described in conjunction with silicone oil surgery of optic pits. In this case however the bubbles were entangled between retina (macula) and ILM. The ILM could be stained and removed over the attached macula. The oil bubbles were aspirated and PFCL was...

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.

Implantation of the Acrysof Cachet phakic IOL with bimanual I/A

Prof. Dr. Michael C. Knorz
This video demonstrates the implantation of the Acrysof Cachet phakic IOL in a highly myopic patient in topical anesthesia. Bimanual I/A is used to remove the viscoelastic material after implantation.

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...

IOL Luxation during silicone oil removal

Bernd Kirchhof
In an eye with a subluxated IOL and during silicone oil removal, all of a sudden the IOL disappears, possibly because the caspular bag was aspirated with the oil. Soon thereafter the iris is transiently aspirated by the aspiration needle. The IOL is found on the retina of the posterior pole. It is elevated with a flute needle (silicone tipped), grasped with foreps by its haptics and extracted via a sclerotomy. Later on a chamger...

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...

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.

Registration Year

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