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....

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...

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.

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...

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.

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...

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.

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,...

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...

This video shows our straightforward appraoch for canaloplasty (Department of Ophthalmology, Radboud University Medical Centre, Nijmegen, NL)

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...

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...

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...

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...

This BBG is not heavier than water, thus no admixture of glucose, not cooled down, and no admixture of heavy water yet. It does stain the ILM sufficiently but somewhat less intense than the heavier than water ICG. The intensity of the staining is sufficient to identify and peel the ILM.

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...

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.

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...

The retinal fold crossed the macula and was a residuum of retinal detachment surgery with vitrectomy and gas tamponade. The video shows the flattening of the fold across the macula via vitrectomy approach, submacular fluid injection and retinal massage from a manipulator.

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.

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...

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...

In the sixth of nine clips in a first grade classroom, four children: Stephanie, Gerardo, Sean and Aaron, revisit and reconsider their solution to Problem 5 of a set of 6 word problems involving addition and subtraction. Refer to clip 4 of the series for their initial work. Stephanie rereads the problem to the group, questioning whether their first answer of 5 is correct. Sean claims that the answer should be 5 plus 3 or...

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.