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...

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...

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.

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...

The overly hard fluid jet of liquid perfluorocarbon directed towards the posterior pole of the eye near the retinal surface perforates the fovea. Most of the subretinal fluid escapes spontaneously via a pre-existing retinotomy. Remnants of submacular PFCL are being evacuated by the pressure of a preretinal PFCL bubble and subretinal aspiration. The procedure is completed by submacular transplantation of autologous pigment epithelium and choroid. The iatrogenic macular hole is addressed by ILM peeling.

Trabeculectomy Limbus Based, Mitomycin,

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...

Zhengang Wang, Former Vice Chairman of the Dandong Municipal Committee of the Chinese People's Political Consultative Conference, was interviewed by the Asia Society staff in Dandong, China on August 14, 2009.

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...

Core vitrectomy, posterior vitreous separation if not yet present, vitreous base shaving, usually those eye are pseudophakic otherwise the natural lens can be shifted anteriorly by anterior chamber drainage, so that the vitreous base is accessible without damage to the lens. BSS injection is used to detach the retina, first transretinally to create a retinal bleb of sufficient size to allow further BSS injection transretinally via a 30 or 27 gauge cannula. As long 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...

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...

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.

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...

Fornix based trabeculectomy with mitomycin C.

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...

The standard fixation of an encircling belt is a permanent scleral suture. Sutures have the disadvantage that they eventually may protrude through the conjunctiva, they may cut through the sclera causing dislocation of the belt, or they may be assciated with infections. The scleral loop requires only a round knife (Teller-Messer), formed like a plate. In case of very thin (blue) sclera a suture will not hold and extra sclera need to be sutured onto...

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...

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...

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...

You see the surgical maneuvre of implanting an artificial retina into a left eye. Key goals are to avoid infection and ocula hypotony. In retintis pigmentosa it seems to be difficult to achieve porsterior vitreous separation. ILM Peeling is tedious, because of adherent and thin ILM.

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....

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...

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....

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...