1,603 Works

23 gauge vitrectomy and subretinal rTPA injection for submacular hemorrhage

Joachim Puchta & Alireza Mirshahi
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....

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.

Incision making in small gauge surgery

Manish Nagpal
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...

RPE and Choroid Translocation in Anti-VEGF-Non-Responder

Bernd Kirchhof
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...

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,...

Hamartoma of the optic disc and the retinal pigment epithelium

Bernd Kirchhof
A combined hamartoma of the optic disc and the RPE may show as a submacular CNV or/ and an epimacular gliosis. In this example the visual acuity is 20/200 and stable but metamorphopsia is a constant complaint. The surgical approach aims to release epiretinal traction via ILM peeling and thereby improve the metamorphopsia. No epiretinal tissue is found, since the ILM stains homogenously. A fibrous tuft is peeled from the optic disc. Since in angiography...

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...

25 gauge vitrectomy techniques for proliferative diabetic retinopathy

Florian Balta
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...

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...

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...

Foreign Body Removal by Vitrectomy and Endomagnet

Bernd Kirchhof
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...

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.

Cataract surgery with penetrating keratoplasty after anterior lamellar dissection

Non
We introduce a new technique that after anterior stromal dissection, cataract surgery is performed with clear vision, and then, the posterior stroma isremoved and penetrating keratoplasty is completed for an eye that had penetrating keratoplasty and cataract surgery planned. Partial thickness corneal incision was done with a Hessburg-Barron trephine. From the corneal incision, anterior stroma dissection was performed with an angled crescent blade. When the dissection was over, the anterior stroma was excised with a...

PVR Surgery through a Boston Keratoprothesis

Bernd Kirchhof
PVR retinal detachment followed the implantation of a Boston keratoprothesis. The video shows PVR-vitrectomy viewing the back of the eye through the keratoprothesis. The central retina can be seen without problem. The peripheral retina cannot be seen ideally, even with indentation. The alterative is to pull the peripheral retina centrally for retinotomy with the help of a forceps. Basically all necessary steps in PVR surgery can be fullfilled through a Boston keratoprothesis.

Corneal surprise during vitreoretinal surgery

Francisco J. Ascaso, Paula Casas & Enrique Mínguez
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...

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.

Implantation of the Acrysof Cachet phakic IOL with bimanual I/A

Prof. Dr. Michael C. Knorz
This video demonstrates the implantation of the Acrysof Cachet phakic IOL in a highly myopic patient in topical anesthesia. Bimanual I/A is used to remove the viscoelastic material after implantation.

Iatrogenic transfoveal submacular injection of liquid perfluorocarbon

Bernd Kirchhof
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.

A30, Fraction problems: Sharing and number lines (Side View), Grade 4, November 1, 1993, raw footage

Carolyn Alexander Maher, Davis, Robert B. (Robert Benjamin) & Gunnar Gjone
In this raw footage, full-session video, Dr. Davis first introduces Gunnar Gjone as a visiting mathematics educator from Norway. The researcher, Carolyn Maher, begins the session by asking the students to review their conclusions from the previous day’s class when they were asked to share a candy bar equally among the students in their small group. Two groups had been composed of eight students while another was composed of nine students, and their task had...

vitrectomy for Valsalva's maculopathy

M.D. Shaarawy
Valsalva's Maculopathy is an uncommon cause of visual loss in young patients following severe physical exertion,strains,vomiting and sexual intercourse.A video clip describing a vitrectomy procedure to treat that condition.

Towers with Stephanie and Dana, Clip 3 of 5: Checking for duplicates and discovering “cousin” towers

No Name Supplied
In this clip, researcher Alice Alston asks Stephanie and Dana how many towers they have created. The two girls had been working on the Towers Problem introduced in the first clip in this series. After they reply that they have found seventeen towers, Alice points out that their group of towers contains a duplicate tower. Alice then questions the girls about how they can be sure that they have found all the towers, and Stephanie...

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.

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

Retinal detachment after BRVO

Ilian Shandurkov
Very rare complication of BRVO is hudge retinal tear along vessels in the posterior pole. Tractions are usually caused by neovascularization at the site of arterial-vein crossing sites.

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