77 Works

Low viscosity silicone oil as infusion fluid in vitreous hemorrhage

Bernd Kirchhof
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...

Removal of a hemorrhagic hyaloid strongly attached

SDOFTALMOLOGIA.COM.BR
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

Argus II-Epiret

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

Implantation of a Flexible Silicone Iris Diaphragm to Prevent Silicone Keratopathy

Bernd Kirchhof
Indications for a closed iris diaphragm are eye that require a permanent (PVR, aqueous insufficiency) silicone oil tamponade, but are at risk of silicone keratopathy (Aniridia, Aphakia). A former version with a central opening is no longer used, because all indications can be served with the closed flexible type.

Implantation of the Acrysof Cachet Phakic IOL with Passive Irrigation

Prof. Dr. Michael C. Knorz
This video demonstrates the implantation of the Acrysof Cachet phakic IOL in a highly myopic patient. Passive irrigation is used to remove the viscoelastic material after implantation.

iLASIK using IntraLase iFS and Visx STAR S4

Prof. Dr. Michael C. Knorz
The video shows an iLASIK procedure performed with the IntraLase iFS femtosecond laser and the Visx STAR S4 excimer laser.

Intraocular foreign body in the lens

Ilian Shandurkov
Technique for atraumatic viscoexpression of intaocular foreign body affecting the lens is demonstrated in a short video.

Newborn vitreous hemorrhage

Bernd Kirchhof
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...

Normal Posterior Vitreous Separation by Cutter Aspiration

Bernd Kirchhof
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.

Posterior vitreous separation in High Myopia

Bernd Kirchhof
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...

CNV Adherent to Macula

Bernd Kirchhof
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...

PVR in the Superior Retinal Periphery after Tamponade by Heavy Silicone oil

Bernd Kirchhof
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...

The bell pepper experiment: a novel self-sealing “screwcut” incision for sutureless vitrectomy

LO Hattenbach
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,...

Persistent Hyaloid, posterior variant addressed by vitrectomy

Bernd Kirchhof
A prominent pucker-like formation in a child is diagnosed as posterior variant of primary persistent hyaloid. After vitrectomy a thick membrane can be aspirated and peeled of the macula with the cutter. Petechial hemorrhages suggest the ILM is gone with the epimacular membrane, which is confirmed by ICG staining. At the outer prominent rim of this process no further tissue can be peeled off.

Implanting the Argus® II Retinal Prosthesis System in a patient with dry AMD

Manchester Vision Regeneration Lab
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,...

iLASIK after Implantation of a Tecnis Multifocal IOL

Prof. Dr. Michael C. Knorz
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.

Macular Hole in Combination with Pucker

Bernd Kirchhof
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...

Revisonal surgery

Bernd Kirchhof
About six months after implantation the footplate of the epiretinal implant rotated due to twist in the cable. This lead to a loss of contact with the retina. The pin holding the footplate needed to be removed. Finally also the sclerotomy needed to be reopened to abolish the twist in the cable. Unfortunately I pushed the pin through the footplate two times requiring removal of the pin and the spring separately from within the eye.

Removal of Standard Silicone Oil, Influence of Type of Infusion Cannula

Bernd Kirchhof
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...

Silicone oil bubbles entrapped in the vitreous base during silicone oil removal

Bernd Kirchhof
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.

Terson Syndrome showing a circumscribed slackening or detachment of the ILM from the posterior pole

Bernd Kirchhof
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.

Canaloplasty for OPen Angle Glaucoma

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

Removal of heavy silicone oil from the posterior surface of the natural lens

Bernd Kirchhof
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.

Illuminated Cutter plus Chandelier Light

Bernd Kirchhof
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...

Removal of Heavy Silicone Oil Adherent to the Retina with PFCL

Bernd Kirchhof
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...

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