50 Works

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.

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...

RPE and Choroid Translocation in massive submacular hemorrhage

Bernd Kirchhof
Usually when larger blood volumes are being removed from underneath the macula then the RPE goes with the blood. An RPE substitute is then required, either by macular translocation or by translocation of a free transplant of pigment epithelium and choroid. The latter is shown here.

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...

Retinectomy as a Pressure Lowering Procedure

Bernd Kirchhof
The rational for a retinectomy in the context of refractive glaucoma is the fact that the retina is the main barrier for the transition of water from the vitreous cavity to the choroid. The advantage of a retinectomy in refractive glaucoma is, that a retinal hole cannot close/heal. Thus the IOP lowering effect lasts as long as the underlying choroidal sponge is perfused. Complications are PVR retinal detachment. That is why it is advisable to...

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.

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...

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...

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.

Iatrogenic Retinal Dialysis from instruments introduced through the sclerotomy

Bernd Kirchhof
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.

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...

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.

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.

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...

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...

Trabeculectomy Limbus Based

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

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...

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.

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...

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...

ILM Staining Brilliant Blue

Bernd Kirchhof
This BBG is not heavier than water, thus no admixture of glucose, not cooled down, and no admixture of heavy water yet. It does stain the ILM sufficiently but somewhat less intense than the heavier than water ICG. The intensity of the staining is sufficient to identify and peel the ILM.

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  • 2009
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