50 Works

Trabeculectomy Limbus Based

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

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.

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...

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.

Peeling of Epiretinal Membranes in PVR

Bernd Kirchhof
Starfolds in PVR show considerable retinal traction, but the causing epiretinal membrane is rarely clearly to discern from the underlying retinal tissue. One must then grab the navel of the fold and while pulling tangentially learn by the difference in elasticity what is membrane and what is retina. The primary goal is to release traction. An incidental retinal hole is a minor disadvantage over leaving behind epiretinal membranes. However all retinal holes need to be...

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...

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...

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...

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...

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.

Sub-ILM Hemorrhage from a retina macroaneurysm

Bernd Kirchhof
The relevant cause of visual loss is here a preretinal but sub-ILM bleeding from a retina macroaneurysm. Part of the hemorrhage is (typically) intraretina, part subretina, but fortunately these more difficult representations are outside the macula. By peeling of the premacular ILM and aspiration of the fresher premacular blood visual improvement could be achieved.

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.

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.

Missed Posterior Vitreous Separation in a Child with PVR Reaction

Bernd Kirchhof
The surgeon meant to have separated the posterior hyaloid. But especially in children the vitreous separation is likely to be incomplete or non-existent at all despite vitrectomy. Leaving the hyloid in place raises the risk of a PVR reaction. As shown here the fibrous condensations were confined to the hyaloids and no relevant traction was evident on the retina. The indication for vitrectomy was a retinectomy as pressure lowering procedure in refractive glaucoma. I hope...

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.

Retinal detachment after BRVO

Ilian Shandurkov
Very rare complication of BRVO is hudge retinal tear along vessels in the posterior pole. Tractions are usually caused by neovascularization at the site of arterial-vein crossing sites.

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.

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.

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.

Trabeculectomy Fornix Based

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

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...

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.

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...

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.

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.

Registration Year

  • 2009
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Resource Types

  • Film
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Data Centers

  • eyeMoviePedia
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