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2018 “Tell It Like It Is …”

FACULTY Malhar Soni (UK) – Course Director Silvia Bopp (Germany) Giampaolo Gini (Italy/UK) Ziya Kapran (Turkey) Hassan Mortada (Egypt) Grazia Pertile (Italy) ABSTRACT This course will discuss various controversies in the management of retinal detachment, macular surgery, AMD and endophthalmitis. Specific topics will include role of scleral buckling & pneumatic retinopexy in current era, large/failed macular hole management,...

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2018 RETINAWS at EVRS

Kourous A. Rezaei (Course Director)     When the Going Gets Tough The Tough Get Going Challenging Cases in Vitreoretinal Surgery Faculty: Antonio Ciardella, Italy; David Martins, Portugal; Jerzy Nawrocki, Poland; Sengul Ozdek, Turkey; Grazia Pertile, Italy & Malhar Soni, UK Short Synopsis: Retina specialists often work in a “shark-infested” world. Unexpected events are a fact of life. Learning how “not to get bit” is...

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Inverted ILM Flap for the Treatment of Myopic MH

Purpose: To describe the functional and anatomical results of pars plana vitrectomy (PPV) with inverted internal limiting membrane (ILM) flap for the treatment of macular holes with or without retinal detachment (RD) in highly myopic eyes. Methods: Twenty-nine eyes affected by macular hole, associated (n=6) or not (n=23) with retinal detachment in high myopia (average axial length 26.80 mm) underwent PPV with inverted ILM...

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A Polymer-based Interface Restores Light Sensitivity in Rat Blind Retinas

Purpose: Sight restoration is one of the new frontiers for prosthetic devices that enable the electrical stimulation o f neurons. In particular, diseases that affect the retinal pigment epithelium and photoreceptors but preserve the inner retinal layers are preferential targets for implantation of visual prostheses. We recently discovered that primary neurons can be successfully grown onto a transparent photovoltaic organic polymer and...

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ILM Peeling in Patients with Clinically Significant DME: Long-term Outcomes

Background: Diabetic macular edema (DME) is a frequent complication of diabetic retinopathy. It is characterized to increased vascular permeability, due to blood-retinal barriers breakdown. Since macular laser treatment has shown poor efficacy to diffuse edema, surgical option of therapy is discussed. Several studies have proven the efficacy of pars plana vitrectomy (PPV) with inner limiting membrane (ILM) peeling in case of DME with a...

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Lamellar Macular Hole: A Clinicopathologic Correlation of Surgically Excised ERM

Advantages: To better understand the indication of lamellar hole (LM) surgery and to know what to expect from intervention, by observation of OCT. Methods: Nineteen eyes with LM were operated. The epiretinal membrane (ERM) and the internal limiting membrane (ILM) were collected from each eye and sent for histological analysis and immunolabeling. Correlation with the laboratory results and the OCT aspect of the ERM were...

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Autologous Transplantation of RPE & Choroid for Wet AMD: Functional Results and Prognostic Factors After a Long-term Follow-up

Advantages: Choroidal neovascularization in age related macular degeneration (AMD), non-responder to standard care, might be treated with autologous transplantation of retinal pigment epithelium and choroid (PATCH). The purpose was to define prognostic criteria for this surgery, to improve the result. Methods: Thirty eyes underwent PATCH surgery. Follow-up was 36 months. Patients received ETDRS, OCT scan and fluorescein and indocyanine...

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Recent Trends in Management of Proliferative Vitreoretinopathy (PVR), Complicating Rhegmatogenous Retinal Detachment (RRD)

Hassan Mortada (Cairo, Egypt), Grazia Pertile (Verona, Italy) Introduction: PVR is a clinical entity characterized by migration and proliferation of cells, mainly retinal pigment epithelium, glial cells and inflammatory cells, with subsequent formation of non-vascularized membranes on both retinal surfaces, vitreous base and vitreous gel, after a RRD. The cells have contractile properties and can exert traction directly on the retina or...

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Bleb-like Syndrome After Sclera Buckle Surgery for Retinal Detachment

Maria Chiara Freno*, Maurizio Mete, Grazia Pertile (Negrar, Italy) Background: Small bleb-like subretinal lesions (bleb-like syndrome) have been shown to be a relatively common finding after scleral buckling (SB) for retinal detachment (RD), while it is very uncommon after pars plana vitrectomy (PPV). Although bleb-like lesions were previously reported as small pigment epithelium detachment, OCT has demonstrated that they are small focal...

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Treatment of Macular Detachment in High Myopia with Macular Buckle

Barbara Parolini, Grazia Pertile* (Verona, Italy) Advantages: Macular detachment in high myopia is a challenge for the surgeon. Various surgical approaches have been tried in the past years with frequent disappointment either for the rare success or for the difficult surgical strategy. Macular buckle, combined with the relieve of vitreoretinal traction through vitrectomy, may guarantee a higher anatomic success rate than the endobulbar...

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Vitreoretinal Surgery for Retinal Detachment in Retinal capillary Hemangioma (RCH)

Maurizio Mete*, Grazia Pertile (Negrar, Italy) Retinal capillary haemangioma (RCH) is one of the most common expressions of Von Hippel-Lindau (VHL) disease. In case of small- or medium-sized RCHs (up to 2 disk diameters), the standard treatment remains laser photocoagulation or cryotherapy. Various treatments have been proposed such as brachytherapy, external beam radiotherapy, transpupillary thermotherapy, photodynamic therapy and...

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Management of Massive Suprachoroidal Hemorrhage

Grazia Pertile, Maurizio Mete (Negrar, Italy) Advantages: 2 steps management of massive suprachoroidal haemorrhage permits to reduce the risk of severe PVR. Methods: During the development of a massive suprachoroidal haemorrhage the vitreous is pressed anteriorly and that can cause its incarceration in the surgical incisions, it can remain trapped in the anterior chamber or it may stick on the posterior surface of the iris. Choroidal...

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Intravitreal Injection of Bevacizumab for Treatment of Subfoveal and Juxtafoveal Choroidal Neovascularization Associated with Pathologic Myopia: 2-Year Follow-Up

http://www.evrs.eu/medias/2010/congress/Non-Age-Related-Macular-Degeneration-Nor-Diabetes-Neovascularization.flv Barbara Parolini, Grazia Pertile (Verona, Italy) Advantages: The results of our study would advise an on-demand intravitreal injection of bevacizumab (IVB) for juxtafoveal and a monthly scheme for subfoveal myopic choroidal neovascularization (CNV). Methods: We retrospectively analyzed the charts of 45 patients with myopic CNV...

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Peripheral Exudative Hemorrhagic Chorioretinopathy: Therapeutic Options

http://www.evrs.eu/medias/2010/congress/Non-Age-Related-Macular-Degeneration-Nor-Diabetes-Neovascularization.flv Grazia Pertile, Barbara Parolini, Matteo Cereda (Negrar, Italy) Advantages: Peripheral exudative hemorrhagic chorioretinopathy is a quite infrequent disease that can seriously threat visual function, especially in the case of bilateral presentation. We have to cope with massive exudation and/or large pigment epithelium...

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Macular Translocation versus Autologous RPE and Choroid Transplantation for Exudative ARMD: Indications and Prognostic Factors

http://www.evrs.eu/medias/2010/congress/Age-Related-Macular-Degeneration-2.flv Barbara Parolini, Grazia Pertile (Verona, Italy) Advantages: Exudative AMD may benefit from different surgical approaches, when the standard of care is not successful. The efficacy of macular translocation or autologous RPE and choroid transplantation is linked to specific prognostic factors. The knowledge of the prognostic factors may guide the indications for...

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Vitrector vs Bimanual Technique for the Surgical Treatment of Proliferative Diabetic Retinopathy: Is the New Always the Best?

http://www.evrs.eu/medias/2010/congress/Proliferative-Diabetic-Retinopathy.flv Barbara Parolini, Grazia Pertile (Verona, Italy) The new gauges and vitrectomy machines are leading to a wider use of the vitrectomy probe for various and finer surgical steps. The 23, 25, and 27 Gauges seem to be able to substitute the scissors for peeling and cutting membranes in PVR and PDR. However this talk is designed to present some surgical scenarios of...

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Coat’s Syndrome Successfully Treated with Cryocoagulation and Intravitreal Injection of Bevacizumab: A Case Report

http://www.evrs.eu/medias/2010/congress/Vascular-Pathologies-in-Young-Patients.flv Barbara Parolini, Grazia Pertile (Verona, Italy) A 14-year-old boy came to our attention in August 2008 for vision loss in the left eye. Since January 2008, his left eye had progressivery lost vision to 0,1 Snellen BCVA. He presented with a massive submacular exudation due to vascular abnormalities located in the temporal quadrant. A choroido-retinal...

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Surgical Techniques to Treat Posterior Retinal Detachment and Macular Hole in Degenerative Myopia

http://www.evrs.eu/medias/2009/congress/High-Myopia.flv Authors: Barbara Parolini, Emilia Maggio, Grazia Pertile, Verona, Italy Advantages: The optimal surgical strategy to treat posterior retinal detachment in high myopia has not yet been established. The authors think that surgery should be tailored based on the axial length and the shape of the posterior staphyloma. Methods: The charts of 28 high myopic eyes with posterior retinal...

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Surgical Treatment of Submacular Hemorrhage

http://www.evrs.eu/medias/2009/congress/Hemorrhages.flv Authors: Grazia Pertile, Barbara Parolini, Verona, Italy Advantages: The treatment of submacular hemorrhage may benefit from different treatments on the bases of the hemorrhage’s area and location. Methods: Submacular hemorrhages located only under the retina and not under the retinal pigment epithelium (RPE) and involving an area within the arcades, were treated with intravitreal...

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Macular Translocation with 360-Degree Retinotomy for the Managment of Retinal Pigment Epithelial Tear: 3 Years Results

http://www.evrs.eu/medias/2009/congress/Surgery.flv Authors: Barbara Parolini, Grazia Pertile, Verona, Italy To determine whether macular translocation with 360-degree retinotomy can stabilize and / or improve visual acuity in patients with retinal pigment epithelium (RPE) tear, given the increasing number of reports on this complication following vascular endothelial growth factor (VEGF)-modulating therapy. Methods: Prospective...

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Incidence of Cystoid Macular Edema in Combined versus Non-Combined Transconjunctival Sutureless 23 Gauge Pars Plana Vitrectomy for Epiretinal Membrane Removal

http://www.evrs.eu/medias/2009/congress/Combined-or-not-Combined.flv Authors: Barbara Parolini, Grazia Pertile, Verona, Italy Advantages: The removal of the crystalline lens combined with pars plana vitrectomy is advantageous in order to completely remove the vitreous body and to spare the patient from further surgery. However, when pars plana is performed to remove an epiretinal membrane (ERM) and internal limiting membrane (ILM) and is...

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Incidence of Retinal Detachment after Transconjuctival 23 Gauge Pars Plana Vitrectomy

http://www.evrs.eu/medias/2009/congress/How-to-Reduce-Complications.flv Authors: Barbara Parolini, Grazia Pertile, Verona, Italy Advantages: To report the rate of postoperative retinal detachment in 943 consecutive eyes operated with 23-gauge transconjuctival pars plana vitrectomy. Methods: Single-center, retrospective, noncomparative, interventional case series. Nine hundred and forty-three eyes underwent 23-gauge transconjunctival...

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Our Way in Viewing the Eye

http://www.evrs.eu/medias/2009/congress/Viewing.flv Authors: Barbara Parolini, Grazia Pertile, Verona, Italy The combination of advantages of the Biom and contact lens will be presented over other viewing systems for most of the vitreoretinal cases in our practice. In summary, the contact lens is used merely for manoeuvres at the posterior pole while Biom is used in every other intraocular surgical step.

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Our Way in Illuminating the Eye

http://www.evrs.eu/medias/2009/congress/Illumination.flv Authors: Grazia Pertile, Barbara Parolini, Verona, Italy The advantages and the disadvantages of various illuminating systems will be presented, with particular attention to the 20g illuminated infusion cannula, the 20g illuminated spatula, the 25g chandelier, the 23g light which can be inserted into the trocars, the 27 g twin-lights and the direct illumination through the microscope....

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Management of Traumatic Corneal Tissue Loss

http://www.evrs.eu/medias/2008/congress/Management-of-Traumatic-Corneal-Tissue-Loss.flv Grazia Pertile, Barbara Parolini Advantages: Some trauma cases may present with corneal tissue loss. In those cases, a simple corneal suture, while may be used as emergency treatment, is not adequate to restore anatomy and function. The use of a scleral patch to replace the lost corneal tissue allows to perform a corneal transplantation. If necessary,...

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Management of Subretinal Perfluorocarbon Liquid

Barbara Parolini, Grazia Pertile Advantages: Perfluorocarbon liquid (PFCL) may slip under the retina in complex cases of PFCL/silicone oil exchange with large retinotomies.  External scleral massage with a scleral depressor may help in extruding PFCL residues from the subretinal space. Methods: External scleral massage with scleral depressor in order to move the PFCL residues in the direction of the retinotomy and extrude the residues...

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Management of Scleral Thinning with Choroidal Exposure

http://www.evrs.eu/medias/2008/congress/Management-of-Scleral-Thinning-with-Choroidal-Exposure.flv Grazia Pertile, Barbara Parolini Avantages: Advantages: Eyes with thin sclera that have undergone repeated surgical procedures may present areas of scleral thinning or even choroidal exposure and bulging. Methods: Areas of choroidal exposure present also with choroidal bulging. A patch of Tenon may be stretched and sutured over the area of...

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SF6 Gas Tamponade: The Easy Way

http://www.evrs.eu/medias/2008/congress/SF6-Gas-Tamponade:-The-Easy-Way.flv Barbara Parolini, Grazia Pertile Advantages: Gas tamponade with SF6 may be easily obtained without complex air-gas exchange procedure. Methods: At the end of pars plana vitrectomy, complete air filling is performed. A volume of 0.7 to 1cc of SF6, based on the dimension of the eye, is directly injected into the eye with a syringe and a 27-G needle though the...

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Surgical Treatment of Lamellar Macular Hole

http://www.evrs.eu/medias/2008/congress/Surgical-Treatment-of-Lameller-Macular-Hole.flv Barbara Parolini, Grazia Pertile Advantages: Lamellar macular holes may be operated on with restoration of vision and foveal anatomy. Our study presents the results in 30 cases. Also a new hypothesis of lamellar hole formation supported by histological analysis will be presented. Pars plana vitrectomy, internal limiting membrane peeling and air...

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Iris Fixated IOL: Let’s Do Just One Hole

http://www.evrs.eu/medias/2008/congress/Iris-Fixated-IOL:-Let’s-Do-Just-One-Hole.flv Barbara Parolini, Grazia Pertile Advantages: Iris fixated IOL´s are very suitable for secondary lens implantation  in aphakic vitrectomized eyes. Usually the IOLs are implanted performing a superior corneal tunnel plus corneal paracenthesis or secondary scleral accesses. The advantage of the present technique is to make only one corneal...

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23 Gauge: Rate of Sclerotomy Closure & Postoperative Hypotony in 600 Cases

http://www.evrs.eu/medias/2008/congress/23-Gauge:-Rate-of-Sclerotomy-Closure-Postoperative-Hypotony-in-600-Cases.flv Grazia Pertile, Barbara Parolini Advantages: Performing a complete vitrectomy even in 23 G sutureless transconjunctival approach allow a very low rate of postoperative retinal detachment. At the same time the rate of sclerotomy closure is high and the occurrence of postoperative hypotony is rare. In this paper we report the...

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Autologous Retinal Pigment Epithelium and Choroid Transplantation for Exudative ARMD with 180° Peripheral Retinotomy

http://www.evrs.eu/medias/2008/congress/Autologous-Retinal-Pigment-Epithelium-and-Choroid-Transplantation-for-Exudative-ARMD-with-180-Peripheral-Retinotomy.flv Grazia Pertile, Barbara Parolini Advantages: Autologous Retinal Pigment Epithelium (RPE) and choroid transplantation has a rationale in replacing the damaged RPE after surgical removal of a CNV and can be useful in order to restore better visual acuity. We present preliminary...

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