50 Works

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.

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.

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 in High Myopia

Bernd Kirchhof
Vitreo-retinal adhesion is typically extremely tight in high myopia at the posterior pole. Remnants or plaques of hyaloid are often associated with retinal tears, then in conjunction with posterior pole rhegmatogenous retinal detachments. To ignore residual hyaloid would mean to accept a risk of PVR retinal re-detachment. The hyaloid is virtually impossible to discern without the help of triamcinolone. Then it is so adherent that suction is insufficient force to detach it. It requires a...

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...

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...

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.

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...

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...

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.

Terson Syndrome showing a circumscribed slackening or detachment of the ILM from the posterior pole

Bernd Kirchhof
The hypothesis here is that the intravitreal hemorrhage in Terson Syndrome needs to cross the ILM on its way to the vitreous. This way the localized ILM detachment may have occurred. Conversely this supports the idea, that the origin of the hemorrhage is the retinal vessels.

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.

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 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...

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.

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...

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...

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.

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.

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.

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...

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.

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...

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...

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.

Registration Year

  • 2009
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Resource Types

  • Film
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Data Centers

  • eyeMoviePedia
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