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...

Currently several approaches exist for drug delivery to the back of the eye of which intravitreal injection is the most popular. This video described a new technique for drug administration to the back of the eye, namely to the suprachoroid space using a microcatheter. The catheter is introduced under the choroid using a transscleral approach at temporal superior quadrant. The exact position of the microcatheter is visualized by a blinking light source at its tip....

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...

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.

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...

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...

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...

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,...

Intraocular lens (IOL) implantation and fixation techniques are controversial in eyes with insufficient or no capsular support. In such eyes, cataract surgery can be performed using a capsular tension ring and an IOL implanted in the bag. Dislocation of this IOL-capsular bag-capsular tension ring (IOL-CB-CTR) complex is rare, but can happen in cases with zonular dialysis or a history of trauma. We report a technique of removal of the CTR with sutureless fixation of the...

Triamcinolone does clearly demonstrate the hyaloid, but does not help to loosen the vitreo-retinal adhesion. A jet of water directed obliquely onto the surface of the retina finds its way through the hyaloid and is then deflected by the retinal surface into the vitreo-retinal interface unless the jet is too strong. Then it can perforate the retina. Such a jet of fluid is often just enough to lift off the hyaloid locally, allowing the cutter...

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.

Small gauge surgery or sutureless surgery is gaining widespread popularity. Incision making is the key to the success of achieving a good postoperative wound. Various techniques have evolved related to the incision making and this video discusses the steps of making a good incision. Significance of retracting the conjunctiva using a stabiliser and then placing a biplanar incision are demonstrated. Steps to acheive a good incision closure at the time of removal of cannulas and...

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...

Vitrectomy with BSS infusion in massive intraokular hemorrhage is very tiring, because of the impedment of sight from the swirling-up blood. Here a silicone oil of very low viscosity - like 20 cSt - replaces the BSS infusion, does not mix with blood and allows a rapid removal of the blood from within the eye.

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...

The epiretinal implant ARGUS II is placed on the macula in one patient with advanced retinitis pigmentosa to restore some form of visual acuity

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...

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.

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 video shows an iLASIK procedure performed with the IntraLase iFS femtosecond laser and the Visx STAR S4 excimer laser.

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...

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.

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...

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...

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...