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,...
The vitrectomy approach is explorative, because the condition of the retina and optic disc could not be estimated preoperatively through the dense cataract. IOP was low –normal. Since the view to the fundus was at first obscured the lens was removed via a limbal approach by a vitreous cutter. Then a common three port vitrectomy approach was possible showing a fibrotic ciliary body and peripheral retina as a consequence of long standing intermediate uveitis. The...
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...
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...
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.
The retinal fold crossed the macula and was a residuum of retinal detachment surgery with vitrectomy and gas tamponade. The video shows the flattening of the fold across the macula via vitrectomy approach, submacular fluid injection and retinal massage from a manipulator.
The epiretinal implant ARGUS II is placed on the macula in one patient with advanced retinitis pigmentosa to restore some form of visual acuity
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.
The video shows an iLASIK procedure performed with the IntraLase iFS femtosecond laser and the Visx STAR S4 excimer laser.
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...
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...
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...
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...
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.
This video shows our straightforward appraoch for canaloplasty (Department of Ophthalmology, Radboud University Medical Centre, Nijmegen, NL)
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.
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.
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.
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.
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...
The reason for the endoresection is the location of the tumor in the vicinity of the macula. Brachytherapy as only means would likely damage the fovea. Endoresection is always combined with brachytherapy, but after removal of the tumor a much lower dose is needed to “sterilize” the sclera. The vitrectomy after 180 degree retinotomy is performed under air to prevent seeding of tumor cells. Also eventual hemorrhage does not compromise the view. The disadvantage of...
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...
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...
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.
Occasionally and usually unexpected the instrument (light pipe, cutter, forceps) introduced through the sclerotomy pushes forward condensed vitreous that is connected to the peripheral retina. The stress from the induced traction is usually sufficient to create a more or less large dialysis. Being aware of the risk, peripheral fundus inspection with indentation and eventual cryopexy or endolaser is the treatment of choice, not necessarily combined with a tamponade in otherwise attached retina.
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