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...

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...

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...

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...

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.

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 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...

In an eye with a subluxated IOL and during silicone oil removal, all of a sudden the IOL disappears, possibly because the caspular bag was aspirated with the oil. Soon thereafter the iris is transiently aspirated by the aspiration needle. The IOL is found on the retina of the posterior pole. It is elevated with a flute needle (silicone tipped), grasped with foreps by its haptics and extracted via a sclerotomy. Later on a chamger...

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.

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...

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.

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,...

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.

Trabeculectomy Limbus Based, Mitomycin,

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...

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

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.

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 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.

Usually posterior vitreous aspiration can be achieved by moving the cutter close to the attached retina and maximal suction near the disc or over the temporal vascular arcade. Successful PVD can be recognized by the migrating borderline between attached and detached hyaloid, moving from the posterior pole to the periphery in synchrony with the tip of 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...

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...

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.

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...