1,603 Works

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,...

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.

Horseshoe tear at the End of Vitrectomy

Bernd Kirchhof
It is mandatory to inspect the peripheral retina at the end of vitrectomy of incidental retinal tears usually associated with the sclerotomies. These may be preformed or newly formed by incarceration of vitreous base into the sclerotomie during change of instruments.

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

L.-O. 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,...

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...

IOL Luxation during silicone oil removal

Bernd Kirchhof
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...

Removal of Heavy Silicone Oil

Bernd Kirchhof
Removal of heavy silicone oil takes about 3 minutes, due to its low viscosity of a little more than 1000 cSt. The cannula is a peripheral infusion trimmed to the appropriate length. The tip should reach to about the center of the vitreous cavity, may even less. Smaller bubbles of heavy oil can be aspirated from the posterior pole by a flute needle. Inspection of the retinal periphery with indentation is recommended, because bubbles may...

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

Exchange of multifocal IOL decentered in a fibrose capsular bag in the lens-IOL

Marie-José Tassignon
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.

Pucker Membrane does not stain with ICG

Bernd Kirchhof
Even though this is a macular hole this film focuses on the staining characteristics of the accompanying pucker membrane extrafoveally. The epiretinal membrane stands out in negative contrast, as unstained. Once the pucker is peeled then a second application of ICG unreveals the remaining ILM.

Transretinal resection of submacular hemorrhage

Alireza Mirshahi
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...

Optic Disc Pit treated by Vitrectomy and Platelet Concentrate

Bernd Kirchhof
After unsuccessful pretreatment with laser along the temporal circumference of the optic disc (old scars) a vitrectomy is performed, posterior vitreous separation and platelet concentrate. The idea of platelets is to clog the pig. The idea of vitrectomy is to release traction of eventual vitreous strands into the pit. Both rationales are hypothetical.

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.

Laser Refractive Lens Surgery using an Intraocular Femtosecond Laser

Prof. Dr. Michael C. Knorz
This video shows an intraocular femtosecond laser (Alcon LenSx Lasers, Inc, Ft. Worth, TX, USA) used to perform laser refractive lens surgery. The laser uses build-in optical coherence tomography (OCT) to image the cornea, lens capsule and lens. Nucleus liquefaction, capsulorhexis and corneal incisions are then positioned on the screen, and the laser performs lens liquefaction followed by capsulorhexis and corneal incisions. Irrigation/aspiration only is used to remove the liquefied lens nucleus, and an intraocular...

Sutureless intraocular lens fixation of a dislocated intraocular lens - capsular bag - capsular tension ring complex

Kannan Naresh Babu & Ramasamy Kim
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...

Removal of silicone oil from a silicone intraocular lens

Bernd Kirchhof
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...

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.

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...

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.

Trabeculectomy Limbus Based

New York Eye And Ear Infirmary
Trabeculectomy Limbus Based, Mitomycin,

Surgery of proliferative vitreoretinopathy (PVR): A step by step approach

Manish Nagpal & Vikram Mehta
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.

28-29 April 1944. HMCS Haida

Geoff Bird
This 16-part series features stories from sites of memory in Canada related to the Second World War. Conversation kits that include discussion questions and activities for students and the public, along with web links and ideas for additional resources are available for each story and accessible online. Please note, each vignette opens with 20 seconds of silence.

Trabeculectomy Fornix Based

New York Eye And Ear Infirmary
Fornix based trabeculectomy with mitomycin C.

Full Macular Translocation in Exsudative Age Related Macular Degeneration

Bernd Kirchhof
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...

Vitrectomy and Lentectomy in FEVR

Bernd Kirchhof
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.

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