A major goal in surgery of geographic atrophy is the atraumatic creation of a submacular space by subretinal injection of BSS. Often the retinal-RPE-Choroid-adhesion is to tight, that water is insufficient. Then a spatula manoevre is advised with the tip of the spatula pointing to the RPE and choroid. Damage of Bruchs membrane is attempted to later on allow ingrowth of connecting vessels from the original choroid to the transplant. The surgical steps are as...

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.

Ocular nematode infections such as cysticercosis, diffuse unilateral subacute neuroretinitis (DUSN) and filariasis are commonly seen in the developing nations of the world. In this video, we will highlight the features and management of five cases comprising of cysticercosis (intravitreal, subretinal and inside the anterior chamber), diffuse unilateral subacute neuroretinitis and ocular filariasis. The epidemological features, clinical characteristics and medical and surgical options are highlighted. When alive, an intra-vitreal cysticercus can move and shy away...

Exhumé par le Service Public de Wallonie, un matériel archéologique inédit a été retrouvé à l’archéoforum de Liège (Tivoli). Daté de la transition Mésolithique-Néolithique, il pose la question du mode de vie des derniers chasseurs-cueilleurs à l’arrivée des premiers colons agro-pasteurs, il y a environ 7000 ans. Les premiers résultats de l’étude sont livrés, ainsi que ceux des tests expérimentaux conduits au Préhistosite de Ramioul. Ces derniers ont notamment permis de retrouver des techniques préhistoriques...

The following is an edited movie of a previously live-streamed surgical video featuring renowned Consultant Ophthalmologist and Vitreoretinal surgeon Professor Paulo E. Stanga, MD, implanting the Argus® II Retinal Prosthesis System in a patient with dry Age Related Macular Degeneration (AMD). To date, June 2016, over 180 Argus® II devices have been implanted worldwide, and are used routinely in advanced Retinitis Pigmentosa patients. This video, recorded at Manchester Royal Eye Hospital, UK, in April 2016,...

Transconjunctival 25 gauge pars plana vitrectomy has evolved considerably since its introduction. New stiff instruments and technical progress expanded the scope and indications and reduced the limitations. This video shows the author’s experience in 25 gauge vitrectomy used for several indications. Primarily this technique was used for simple vitrectomy, epiretinal membrane peeling and macular hole surgery. Recent improvements in the instrumentation and illumination enable the surgeon to perform sutureless transconjunctival 25 gauge vitrectomy for the...

This video shows an iLASIK procdure using the IntraLase iFS femtosecond laaer and the Visx STAAR S4 excimer laser to perform a wavefront-guided LASIK after implantation of a Tecnis diffractive mutifocal IOL.

The proliferative diabetic retinopathy (PDR) cases are operated on with 25 G instruments, under the OFFISS System as viewing system, and the Constellation vitrectomy machine at 5000 cuts / minute ,using either an unimanual or a bimanual technique. In the unimanual technique, the vitreous cutter is used. In the bimanual technique, the combination between the intraocular forceps and the vitreous cutter is used. Less frequent the illuminated spatula and the forceps are used together. The...

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.

Uveal effusion syndrome (UES) is a difficult condition to accurately diagnose and treat. In this video, we illustrate the features, differential diagnoses and management of UES using a combination of surgical clips and 3D animation. Surgical treatment with sclerectomy is demonstrated, including tips for effective control of sclerectomy depth. Good anatomical and visual outcomes can be achieved following sclerectomy for UES. Uveal effusion syndrome is a challenging condition to diagnose and treat. Good outcomes can...

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...

Several methods have been introduced for the treatment of submacular hemorrhages secondary to age-related macular degeneration. Small bleedings may be dislocated by intravitreal injection of SF6 gas, possibly combined with recombinant tissue plasminogen activator (rTPA). Larger hemorrhages can be treated by pars plana vitrectomy, subretinal injection of rTPA and gas tamponade. Large and particularly thick bleedings may require additional procedures such as subretinal lavage or the surgical removal of blood clots. Moreover, macular translocation surgery...

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.

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...

Trabeculectomy Limbus Based, Mitomycin,

A 65-year old man underwent pars plana vitrectomy for dislocated lens fragments into the vitreous cavity during a previous cataract surgery. The right eye anterior chamber exam showed three nylon 10/0 corneal sutures and fundus examination revealed dislocated lens fragments into the vitreous cavity. There was no history of refractive surgery. The patient was scheduled for a standard 20-gauge three-port pars plana vitrectomy. During the surgery a big epithelial bleb appeared in the corneal surface...

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...

Proliferative vitreoretinopathy (PVR) often leads to failure in retinal detachment surgery. Surgeons need to be well versed with managing different aspects of retinal detachment complicated by PVR to achieve successful outcomes. Various techniques such as membrane peeling, dissection, air fluid exchange , endo-drainage, endo laser, usage of perfluorocarbon liquid (PFCL), retinectomies etc. are shown in detail. Carefully assessing the PVR and managing it can improve the surgical outcomes in these cases.

This video shows 23 gauge sutureless pars plana vitrectomy, subretinal injection of recombinant tissue plasminogen activator (rTPA) and SF6 endotamponade for treatment of a submacular hemorrhage secondary to age-related macular degeneration. The subretinal injection is performed using a 41 gauge cannula. The preferred injection area is the temporal margin of the hemorrhage. Postoperatively, face-down position is necessary for dislocation of the blood. Subsequent treatment of the choroidal neovascular membrane is necessary for disease control, e....

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.

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

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.

Cytogenetic phenotyping is a world-wide accepted procedure in ocular oncology to know the risk of metastatic disease of uveal melanoma. We describe our effective and safe vitreoretinal surgical technique to obtain a sample of melanomas located posterior to the equator. A three-port 25-gauge microcannulae system through the pars plana is used to insert a vitrector or a 27-gauge needle to obtain the tissue, depending on the size of the tumor. Although minimal bleeding may be...

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...

A 30 years old female presented in Disha Eye Hospitals, Barrackpore, West Bengal, India with panuveitis with progressive tractional retinal detachment (TRD) involving macula in right eye. Her left eye was absolutely normal. An actively motile worm was detected at pars plana area at the time of vitreous base excision and removed in intact motile form. The large granulomatous tissue over the disc with thick epimacular membranes were removed. The retina was reattached and silicone...