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Advantages of ILM Blue

Before seeing the advantages of the ILM Blue in ERM surgery, compared to the other dyes, we must analyze what we want to dye: ERM is composed on a plaque of posterior hyaloid which is a collagen 2 structure responsible of reflection and metamorphopsia, the ILM (one micron collagen 4 structure) invaded by glial proliferation (astrocytes and Mueller cell end-feet filled with microfibrils of GFAP). ILM peeling works because, when we remove...

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My Strategy for Floaters

People know that. I’m the first to fight against vitrectomy in a detachment without PVD, to fight against combined surgery when we can avoid it, or to call for a minimal vitrectomy in macular surgery as my concern is always to provoke the minimum trauma; but I am performing 10 to 15 vitrectomies per year for floaters and this can appear paradoxical. I have 2 indications Professional indications: a commercial traveler who cannot drive his...

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Let’s Try to Understand

The EVRS RD study, analyzed by the French National Institute of Statistics, demonstrated that vitrectomy performed with a Venturi pump machine almost triples the failure rate compared to the use a flow-control pump, independently of the surgeon’s experience, age and nationality. Let’s try to explain why. Since a Venturi pump does not allow to control the quantity of liquid entering the hand piece, a low cutting speed cannot be used...

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My Right Fundus. Diagnosis?

                Contact Details: Email: ddd@club-internet.fr Cell Phone:...

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My Left Fundus. Diagnosis?

                Contact Details: Email: ddd@club-internet.fr Cell Phone:...

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Select Your Vitrectomy Machine Parameters with EVA

The EVRS RD study, analyzed by the French National Institute of Statistics, demonstrated that vitrectomy performed with a Venturi pump machine almost triples the failure rate compared to the use a flow-control pump, independently of the surgeon’s experience, age and nationality. Let’s try to explain why. Contact Details: Email: ddd@club-internet.fr Cell Phone:...

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Why Did I Choose ILM Blue?

Before seeing the advantages of the ILM Blue in ERM surgery, compared to the other dyes, we must analyze what we want to dye: ERM is composed on: A plaque of posterior hyaloid which is a collagen 2 structure responsible of reflection and metamorphopsia. The ILM (one micron collagen 4 structure) invaded by glial proliferation (astrocytes and Mueller cell end-feet filled with microfibrils of GFAP). ILM peeling works because, when we remove...

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Parapapillary Break

Contact Details: Email: ddd@club-internet.fr Cell Phone: /+33685555202

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Three Year Old MH

Contact Details: Email: ddd@club-internet.fr Cell Phone: /+33685555202

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RD 2 Days After IVT

Contact Details: Email: ddd@club-internet.fr Cell Phone: +33685555202

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My Way for Optic Pit RD

Media not available due to technical recording problems. EVRS is very sorry for the inconvenience.   My concept of mini-invasive surgery leads me to propose the following strategy: during the evening before the operation, I perform 2 raws of photocoagulation with red laser along the temporal size of the optic pit, in the detached retina; during the following morning I make an anterior chamber drainage followed by a 0.4 ml of C3F8...

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My Machine Parameters for Central and Peripheral Vitrectomy

Media not available due to technical recording problems. EVRS is very sorry for the inconvenience.   During a central vitrectomy I want to remove the central vitreous without hypotonia, to avoid incarceration and to induce retinal tears at the vitreous base level, and I want to do it efficiently. I can easily avoid any hypotonia in choosing my maximum aspiration flow always lower than my maximum infusion flow; so the first thing to do...

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Posterior Iris Claw Implantation for Correction of Aphakia : Technique and Long-term Results

Media not available due to technical recording problems. EVRS is very sorry for the inconvenience.   Purpose: To evaluate the indications, the safety, and the results of retropupillary implantation of iris claw intra ocular lenses in the correction of aphakia Patients and methods: This retrospective study included 50 eyes of 50 patients who underwent retropupillary iris claw IOL fixation between January 2010 and January...

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Interest of Reading Evaluation with an Eye Tracker in Idiopathic Macular Hole Before and After Surgical Treatment

Purpose: To evaluate the effect of idiopathic macular hole on eye movements during reading before and after macular hole surgery. Methods: Twelve patients with unilateral idiopathic full-thickness macular hole were included in this prospective case-control study. In the diseased eye, all patients underwent standard two-port pars plana vitrectomy with posterior hyaloid and ILM removal. Main outcome measures were the number and durations...

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The Machine Which Speaks to the Ear of the Surgeon

Vitrectomy machines equipped with a flow control pump allow not only to decrease by 300% the number of failures in retinal detachment but can also facilitate the surgeon’s work in providing him information on what he is actually doing. The new EVA machine is equipped with a sound system which allows: to inform the surgeon when the infusion is on to inform the surgeon on the positioning of his foot on the foot pedal (telling him what...

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Aspirating Forceps

One of the specifications which can lead to a vitreoretinal incarceration is a high number of entries / exits in the sclerotomy, especially when the anterior vitreous around the sclerotomy is not removed. In order to reduce this risk, the author uses a forceps which contains a tubing connected to the vitrectomy machine pump. This tubing allows: to inject the ILM blue to remove the ILM blue to evacuate small pieces of membrane / ILM just...

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Discussion

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ILM Peeling in RVO

The author initiated the ILM Peeling as a treatment of BRVO and CRVO in February 2000 and is continuing this technique due to the quality of the results: 4,15 LogMAR lines of average improvement 69% of patients improved their visual acuity Only 6,4% of patients had a decreased visual acuity Reduction of the edema (by OCT measurement) of 200 µ We will present, this year, the results after long-term follow-up (more than 5 years) in order...

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Evaluating Adjunctive Surgery to Ozurdex for the Treatment Macular Edema Following RVO

Ozurdex®, a dexamethasone (DEX) intravitreal implant, has been shown in randomized controlled trials to reduce macular edema and improve visual acuity in patients with either branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO). However, repeated injections are usually necessary, particularly for CRVO patients. And the long-term adverse events, including the incidence of cataract and glaucoma, are still...

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What is an ERM; How Could ILM Peeling Work?

An idiopathic epiretinal membrane is a syndrome associating a macular oedema, a reactive astrocytic gliosis and an adherent plaque of posterior hyaloid. The astrocytic proliferation enters the hyaloid fibres so that the typical reflection can appear. When there is no adherent plaque of hyaloid, an aspect of pure oedema is observed. ILM removal has two functions: It removes the hyaloid fibres entirely and therefore treats the retraction...

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ILM Peeling Different Tricks

The author will describe tricks to make the ILM Peeling easier, faster and less traumatic: The use of the ILM blue allows to differentiate the plaque of adherent posterior hyaloid from the “nude” ILM. According to the respective distribution of these two configurations, the peeling can be done differently: If the surface of “nude” ILM is too small, we must start in removing the posterior hyaloid before removing the ILM. If the...

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Pathological Findings in Macular Edema

The retina and particularly the macula react spontaneously to different pathological conditions. In case of retinal detachment, as in case of any injury, there is a stimulation of EGF-R (epidermal growth factor receptor), which regulates the gliosis, the tissue homeostasis, the injury response, the stem cell proliferation, the angiogenesis and the anti-apoptotic factor.  Under EGF-R stimulation, the microglia stimulate the Müller cells,...

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Scleral Buckling for RD

Scleral Buckling for RD

Didier Ducournau Prelude     Rationale, Mechanics and Indications Dehiscence sealing   Relaxation of vitreous tractions    Vitreous base relaxation   Epiretinal membranes traction forces reversal   Associated to scleral shortening http://www.evrs.eu/medias/AwardedVideos/ScleralBucklingforRD_5.flv   Surgical...

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Juxtapapillary Cyst-Like Lesions

Juxtapapillary Cyst-Like Lesions

Didier Ducournau

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The Distal Haptic Technique

The Distal Haptic Technique

Didier Ducournau http://www.evrs.eu/medias/AwardedVideos/The-Distal-Haptic-Technique.flv

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Vitrectomy Indication

Vitrectomy Indication

Didier Ducournau   Introduction   Indication Independent of PVR Stage http://www.evrs.eu/medias/AwardedVideos/VitrectomyIndication-IndicationIndependent.flv   Indication in Stage 0 http://www.evrs.eu/medias/AwardedVideos/VitrectomyIndication-IndicationinStage0.flv   Indication in Stage A http://youtu.be/szd7qTcCoEA [br] ...

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How to Minimize Scleral Buckling Complications?

Frank Becquet, Jean-François Le Rouic, Didier Ducournau (Nantes, France) Purpose: To evaluate the use, tolerance and complications of episcleral implants in retinal detachment surgery. Methods: A review was carried out on the medical reports of 2155 patients with a single surgical procedure (cryotherapy and scleral buckling) for rhegmatogenous retinal detachment that were operated on by three surgeons (Frank Becquet, Jean-François Le...

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Management of Exudative Retinal Detachment Following Surgery in Nanophthalmic Eyes

Frank Becquet, Jean-François Le Rouic, Didier Ducournau (Nantes, France) Purpose: To report three cases of nanophthalmic uveal effusion syndrome with exudative retinal detachment after intraocular surgery. Methods: Three patients were referred to us with a persistent exudative retinal detachment after intraocular surgery (surgery of glaucoma in two cases and cataract in one case). Sclerectomy and vortex vein decompression were performed...

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Macular Hemathoma Due to ARMD in the Era of Anti-VEGF: Has Anything Changed?

http://www.evrs.eu/medias/2010/congress/Hemorrhages.flv Jean-François Le Rouic, Frank Becquet, Didier Ducournau (Nantes, France) Introduction:  Although anti-VEGF therapy is a breakthrough in the treatment of exudative age-related macular degeneration (ARMD), sub-macular haemorrhage remains a major concern which may still need surgical treatment when the bleeding is large and thick.  We wondered if the main characteristics and the...

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Is Idiopathic Epiretinal Membrane a Kind of Chronic Retinal Vein Occlusion?

http://www.evrs.eu/medias/2010/congress/Branch-Retinal-Vein-Occlusion-Central-Retinal-Vein-Occlusion.flv Frank Becquet, Xavier Zanlonghi, Jean-François Le Rouic, Didier Ducournau (Nantes, France) Purpose: To evaluate retinal macular function by multifocal electroretinogram (mfERG) in patients with idiopathic epiretinal membrane (ERM) or retinal vein occlusion (RVO). Methods: In this retrospective comparative study, records of nine patients...

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Dissection of Proliferative Diabetic Retinopathy Using the Vitreotome with Flow Control

http://www.evrs.eu/medias/2008/congress/Dissection-of-Proliferative-Diabetic-Retinopathy-Using-the-Vitreotome-with-Flow-Control.flv Jean-François Le Rouic, Frank Becquet, Didier Ducournau Advantage: The precise aspirating flow control of recent vitrectomy machines and the reduction of the vitreotome port allow for a selective grasping and cutting of preretinal proliferations. This technique reduces the need for iterative exits through the...

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Stem Cells Implantation: Is it the Way of the Future?

http://www.evrs.eu/medias/2008/congress/Stem-Cells-Implantation:-Is-it-the-Way-of-the-Future.flv Yvette Ducournau, Claude Boscher, Didier Ducournau Stem cells have been identified in vitro in the Ciliary Body (« ciliary margin ») of animals and  in post mortem adult human eyes. To our knowledge, culture of Ciliary Body-derived Retinal Progenitors from the adult human eye in vivo has never been published. We have very recently presented...

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Miscellaneous Medical Session

http://www.evrs.eu/medias/2007/videos/miscellaneous.flv

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New Vessels Session

http://www.evrs.eu/medias/2007/videos/newvessels.flv

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RD External Procedure Session

http://www.evrs.eu/medias/2007/videos/rdexternalprocedure.flv

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Vitrectomy Session – Closing the Sclerotomies

http://www.evrs.eu/medias/2007/videos/vitrectomysession-closingthesclerotomies.flv

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Vitrectomy Session – Subretinal Bubbles

http://www.evrs.eu/medias/2007/videos/vitrectomysession-subretinalbubbles.flv

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Vitrectomy Session – Hemorrhages

http://www.evrs.eu/medias/2007/videos/vitrectomysession-hemorrhages.flv

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Vitrectomy Session – Lenses

http://www.evrs.eu/medias/2007/videos/vitrectomysession-lenses.flv

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Vitrectomy Session – Peeling

http://www.evrs.eu/medias/2007/videos/vitrectomysession-peeling.flv

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Vitrectomy Session – Removing the Vitreous

http://www.evrs.eu/medias/2007/videos/vitrectomysession-removingthevitreous.flv

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Vitrectomy Session – Infusion Line

http://www.evrs.eu/medias/2007/videos/vitrectomysession-infusionline.flv

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Vitreo Retinal Pathologies

Vitreo Retinal Pathologies

Didier Ducournau http://www.evrs.eu/medias/AwardedVideos/VitreoRetinal-Pathologies.flv

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Particular Profile for Idiopathic Central Retinal Vein Occlusion in Young Adults

Frank J. Becquet, MD, PhD (Nantes, France), Jean-François Le Rouic, MD (Nantes, France), Didier Ducournau, MD (Nantes, France) PURPOSE: To describe and evaluate the prevalence of intensive sport practising among patients with earlyonset central retinal vein occlusion (CRVO). METHODS: Intensive sport practising was evaluated in a consecutive series of 10 patients with CRVO who were younger than 45 years of age (mean age, 37.2 years) from a...

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Internal Limiting Membrane Peeling in Macular Surgery: a Common Physiopathological Mechanism Suggested by Functional Results

http://www.evrs.eu/medias/2005/congress/Internal-Limiting-Membrane-Peeling-in-Macular-Surgery:-a-Common-Physiopathological-Mechanism-Suggested-by-Functional -Results.swf Jean-François Le Rouic, Didier Ducournau, Frank Becquet Purpose: To investigate visual acuity (VA) outcomes after internal limiting membrane (ILM) peeling in macular idiopathic epiretinal membrane (ERM), diabetic macular edema (DME), macular hole (MH), and chronic macular...

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Slit Lamp Illumination for Bimanual Surgery in the Treatment of Proliferative Diabetic Retinopathy

J.F. Le Rouic, F. Becquet, D. Ducournau Purpose: To report the usefulness of the slit lamp which allows bimanual surgery in complex retinal surgery such as proliferative diabetic retinopathy. Methods: Presentation of demonstrative cases in which bimanual surgery under slit lamp illumination was helpful for the treatment of proliferative diabetic retinopathy. Results: During surgery, slit lamp provides a good illumination of the fundus and a...

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Evaluating Adjunctive Surgical Procedures of Vitrectomy for Diabetic Macular Edema with Visual Acuity and Optical Coherence Tomographic Outcomes

F. Becquet, J.F. Le Rouic, D. Ducournau, Department of vitreo-retinal surgery, Clinique Sourdille, Nantes, France Purpose: To investigate visual acuity and optical coherence tomographic (OCT) outcomes, and adverse events, associated with intravitreal triamcinolone acetonide (TA) injection and pars plana vitrectomy for diabetic macular edema (DME). Methods: Retrospective, non-comparative, interventional, consecutive case series. Records were...

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Risk Factors for Recurrence and Failure after Vitrectomy Versus Scleral Buckling in Rhegmatogenous Retinal Detachment Surgery

Claire Douat, Frank Becquet, Didier Ducournau, Nantes, France Purpose: Retinal reattachment can be achieved by different surgical approaches such as primary posterior vitrectomy (PPV) or scleral buckling techniques (SB). Recently, PPV as a first intention treatment for rhegmatogenous retinal detachment (RRD) has become fashionable in comparison with SB. The aim of this retrospective study was to evaluate the risk factors for RRD recurrence...

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