50 Works

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...

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...

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.

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.

Subchoroidal Infusion with Air, Water, Silicone oil

Bernd Kirchhof
The typical situation for subchoroidal infusion is ocular hypotony. In the first instance hypotony exists because an infusion in place is removed and another infusion is introduced through the same sclerotomy. The line contains air which instantly escapes through the adjacent sclerotomy for the light pipe. An angulated spatula is used from the opposite site of the infusion to free the tip of the subchoroidal infusion cannula from ciliary body tissue. Eventual remaining subchoroidal air...

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...

Rupture of the Eye after Bomb Explosion

Bernd Kirchhof
The situation of rupture of both eye balls concerned both eyes after a bomb explosion as a criminal attack. The patient had “perception of light” in both eyes. One eye was primarily enucleated. The other eye was reconstructed as shown here. This is meant as an example of successful reconstruction in an assumingly hopeless situation and as a reason against primary enucleation at the time of emergency surgery. Since there was no ciliary body and...

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.

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 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...

Trabeculectomy Limbus Based

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

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...

Terson Syndrome showing a circumscribed slackening or detachment of the ILM from the posterior pole

Bernd Kirchhof
The hypothesis here is that the intravitreal hemorrhage in Terson Syndrome needs to cross the ILM on its way to the vitreous. This way the localized ILM detachment may have occurred. Conversely this supports the idea, that the origin of the hemorrhage is the retinal vessels.

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.

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.

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.

Vitrectomy and Lentectomy in Childhood Uveitis

Bernd Kirchhof
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...

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...

Intraocular foreign body in the lens

Ilian Shandurkov
Technique for atraumatic viscoexpression of intaocular foreign body affecting the lens is demonstrated in a short video.

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...

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.

Macular Hole in Combination with Pucker

Bernd Kirchhof
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...

Removal of Standard Silicone Oil, Influence of Type of Infusion Cannula

Bernd Kirchhof
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...

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  • 2009
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