1,603 Works

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...

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...

Primary Vitrectomy

Bernd Kirchhof
Primary vitrectomy has largely replaced bucking procedures because the procedure requires less experience, is more controlled and the retina is attached at the end of the intervention. The steps are as follows. Three port vitrectomy access, core vitrectomy, liquid perfluorocarbon, vitreous base shaving, eventually removal of the flap of the horseshoe tear, PFCL and BSS exchange against air to release subretinal fluid through the retinal hole, laser-or kryo-retinopexy around the hole and eventually 360 retinotomy,...

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...

Scleral loop to fixate an encircling band

Bernd Kirchhof
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...

Suprachoroidal drug delivery: A novel approach in treatment of wet age-related macular degeneration (AMD)

Gabor B. Scharioth
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....

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.

Posterior Vitreous Separation by Tano Scraper

Bernd Kirchhof
There are few instances when either triamcinolone or fluid jet are insufficient to help detach the hyaloid. This is my only indication in vitreo-retinal surgery to use a Tano scraper. Its rough and sticky “tongue” entangles with the collagen fibres of the hyaloid and can provide the starting edge for the cutter.

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.

Simulated missing of ILM in Uveitis asssociated macular edema with overlooked hyaloid attached

Bernd Kirchhof
Initially, I was uncertain whether there was ILM at all, since ICG staining did not stain at all, not the posterior pole, not the ILM outside the posterior pole. Only after more or less blind peeling a preretinal sheet unraveled, that turned out be attached thick changed hyaloid, preventing the staining of the ILM. After posterior vitreous separation staining of the ILM was possible as usual. The reason for a completely negative ILM staining may...

Low viscosity silicone oil as infusion fluid in massive subretinal hemorrhage

Bernd Kirchhof
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.

Sub-ILM Hemorrhage from a retina macroaneurysm

Bernd Kirchhof
The relevant cause of visual loss is here a preretinal but sub-ILM bleeding from a retina macroaneurysm. Part of the hemorrhage is (typically) intraretina, part subretina, but fortunately these more difficult representations are outside the macula. By peeling of the premacular ILM and aspiration of the fresher premacular blood visual improvement could be achieved.

Argus II epiretinal Implant, Cologne

Bernd Kirchhof
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.

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.

Endoscopy Assisted Argus II Epiretinal Prosthesis Implantation

SSMP
Endoscopy Assisted Argus II Epiretinal Prosthesis Implantation Surgical Video Recording done by Prof. Emin Ozmert, in Ankara University Vehbi Koç Eye Hospital, Ankara - TURKEY. By using endoscopic imaging during Argus II Retinal Implant surgery, it's easier to see that the ciliar body isn't damaged due to scleratomy as well as the retinal tack is in place and the spring is squeezed properly.

Missed Posterior Vitreous Separation in a Child with PVR Reaction

Bernd Kirchhof
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...

Posterior Vitreous Separation by a Combination of Triamcinolon and Fluid Jet

Bernd Kirchhof
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...

aniridia aphakia implant and corneal transplant surgery

Dr. Barbara Parolini Carbognin
the patient had undergone perforating trauma with loss of corneal tissue, aniridia aphakia and retinal detachment. the first surgery was performed to repair retinal detachment and to perform the first corneal transplant, with a gain in vision to 0,1 Snellen acuity pinhole. the corneal graft failed after silicone oil removal. one further surgery (Video) was planned to replace the corneal graft and to reconstruct the anterior segment with an aniridia aphakia implant.

Membrane on the back Side of the ILM Causing Pucker-like Distortions

Bernd Kirchhof
Even though the ILM stains homogenously the ILM is distorted like in a pucker. The explanation is that the causative membrane resides on the back side of the ILM and bridges to the retina, possibly glial tissue. Thus ILM is a substrate and precondition for membrane formation not matter on which side of the ILM membranes develop.

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...

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...

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,...

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...

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.

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