77 Works

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)

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.

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...

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,...

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...

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.

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...

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.

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...

Newborn vitreous hemorrhage

Bernd Kirchhof
vitreous hemorrhage in a newborn is a challange: Why hemorrhage: ROP? Malformation? Trauma during delivery? Iatrogenic damage to the lens and peripheral retina is at risk. Here the indication was: no pupullary red reflex, while the other eye was normal and the risk was amblyopia. The removal of the vitreous with trocar access went normal. However the infusion line slipped from the clip. The tip of the trocar leaned against the lens equator. Fortunately the...

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.

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.

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...

PVR Surgery through a Boston Keratoprothesis

Bernd Kirchhof
PVR retinal detachment followed the implantation of a Boston keratoprothesis. The video shows PVR-vitrectomy viewing the back of the eye through the keratoprothesis. The central retina can be seen without problem. The peripheral retina cannot be seen ideally, even with indentation. The alterative is to pull the peripheral retina centrally for retinotomy with the help of a forceps. Basically all necessary steps in PVR surgery can be fullfilled through a Boston keratoprothesis.

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...

Removal of Heavy Silicone Oil Adherent to the Retina with PFCL

Bernd Kirchhof
Rarely heavy silicone oil is so adherent to the retina that it does not coalesce during aspiration. It is of course nerve racking to aspirate with high suction very close to the retina and still not be able to completely remove the oil. The remedy is to add liquid perfluorocarbon to the layer of adherent silicone oil. The adhesion to PFCL is much stronger than to the adhesion to the retina. One must add as...

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.

ILM does not Reform, once it is Removed

Bernd Kirchhof
This short film shows that the macula area is spared from ICG staining one year after the ILM was removed from the same spot. Apparently ILM, once it is peeled, cannot rebuild. Sine ILM is a precondition to epiretinal membrane formation, ILM peeling should protect from pucker recurrence.

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...

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.

Implantation of the Acrysof Cachet Phakic IOL with Passive Irrigation

Prof. Dr. Michael C. Knorz
This video demonstrates the implantation of the Acrysof Cachet phakic IOL in a highly myopic patient. Passive irrigation is used to remove the viscoelastic material after implantation.

Retinal Injury from Light Pipe

Bernd Kirchhof
Unexperienced surgeons must permanently observe both instruments in the eye, if not, both instruments must be removed. In this case the resident is so diverted by a first successful ILM peeling that on removing the forceps uncontrolled movement of the light pipe – still in the eye - ends up in a retinal hole inferior to the macula. No noticeable functional loss remained. The procedure was completed as planned by fluid gas exchange for macular...

Rupture of the Eye after Bomb Explosion

Bernd Kirchhof
The situation of rupture of both eye balls concerned both eyes after a bomb explosion as a criminal attack. The patient had “perception of light” in both eyes. One eye was primarily enucleated. The other eye was reconstructed as shown here. This is meant as an example of successful reconstruction in an assumingly hopeless situation and as a reason against primary enucleation at the time of emergency surgery. Since there was no ciliary body and...

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.

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.

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