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Our Experience in Treating Floaters

Treatment for symptomatic floaters range from floater reduction using laser strategies to full vitrectomy necessitating a surgical PVD. Furthermore, patient’s individual perceptions of vitreous opacities differ significantly, and therefore treatment strategies must respect their expectations. A subgroup of patients suffers heavily and is almost not able to continue normal daily life or work, although floaters are hardly detectable by...

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Tell It Like It Is …

Advanced Vitreo Retinal Surgery Symposium “Tell It Like It Is…” or “TILII” symposium will provide discussions with ‘guaranteed political incorrectness’ on various controversial vireo-retinal surgery topics.                   Malhar Soni, UK (Moderator) Panelists: Jean-Paul Berrod, France Abdhish Bhavsar, USA Didier Ducournau, France Ferenc Kuhn, USA Klaus Lucke, Germany Jerzy...

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If I Could Develop an Ophthalmosurgical Machine….

…it first of all would not be called ”phako machine“ or ”vitrectomy machine“ since it would handle both with equal perfection, just as a good vitreoretinal surgeon does both with equal skill. At this meeting we can discuss at length which is the best machine. Unfortunately none of the machines available to us is really perfect. Therefore, in this presentation I would like to list and explain those features that a machine must...

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TTT-like Laser Coagulation of Peripapillary Neovascular Membranes

Media not available due to technical recording problems. EVRS is very sorry for the inconvenience.   In eyes with AMD or other choroidal pathologies prone to develop subretinal neovascular membranes we occasionally encounter cases where the CNV is localized around the optic disc, giving rise to an exudative retinal detachment frequently involving the macula and reducing visual function. When the CNV does not involve the foveal zone...

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Surgery for Optic Pit with Macular Schisis/Detachment

Media not available due to technical recording problems. EVRS is very sorry for the inconvenience.   Advantages: To demonstrate an effective technique towards successful optic pit surgery. Methods: 17 eyes were operated on between 1999-2013 17 eyes with vitrectomy, PVD, ILM-peeling, laser around the pit and gas tamponade. Follow-up was 42-3610 days (median 762). OCT-imaging was available for 11 cases (2003 and later). Two examples...

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An iPad Application for Fundus Drawings

Purpose: In spite of the availability of good quality wide-angle fundus photography, fundus drawings continue to be highly useful for documenting pertinent features found at the time of fundus examination or as a method of documenting a surgical procedure, highlighting the important facets of an operation. They also serve well as a didactic instrument in the training of retinal specialists. In the age of electronic medical records the...

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Postoperatively Persistent Macular Holes: Visual Acuity Development with and Without Further Treatment

Postoperatively persistent macular holes after primary vitrectomy are a rare but regular finding. The strategy for further treatment of these cases is still under debate and ample treatment recommendations have been published. We analysed the outcome of untreated persistent macular holes as well as after gas injection or second vitrectomy with different endotamponades. Methods: In a retrospective case control study we analysed the...

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Comparative Evaluation of Indocyanine Green and Brilliant Blue Assisted Internal Limiting Membrane Peeling During Macular Hole Surgery

Purpose: To evaluate the anatomical closure rate and visual outcomes in patients undergoing pars plana vitrectomy with internal limiting membrane peeling with either indocyanine green staining and methylcellulose protection of the macular hole (group 1) or brilliant blue staining of the ILM (group 2). Methods: Non-controlled, retrospective case series of 187 eyes which underwent macular hole surgery between March 2007 and October 2009....

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Literature & Posters Review

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Vitrectomy for DME – An Alternative to Anti-VEGF Therapy?

Advantages: Vitrectomy for diabetic macula edema (DME) is and was used as a second line treatment. Published studies about this therapy option report mainly about small numbers of patients and show heterogenous results. In these times, when ranibizumab starts to dominate the therapy of DME, we want to present the functional results of vitrectomy for DME in a larger number of treated eyes. Methods: Retrospective analysis of the...

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Cystoid Macular Edema in Retinitis Pigmentosa

Advantages: To report on medical and surgical treatment for retinitis pigmentosa-associated cystoid macular edema (CME). Retinitis pigmentosa is a progressive inherited retinal disease and one of the main causes of acquired blindness in developed countries. There is no approved therapy able to stop the degeneration of the photorecptor cells and the retinal pigment epithelium. The current management using medical and surgical therapy...

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Silicone Oil

Klaus Lucke (Bremen, Germany) The purpose of the course is to give young surgeons with some basic experience in the use of silicone oil in complicated detachments some guidance in its use. Once a surgeon starts using oil, experience shows that due to the rather complicated matter very quickly numerous problems and questions arise. This course is intended to serve as a forum for asking these questions and getting real life answers to take...

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Silicone Oil in Retinal Detachments – Proposed Mechanisms of Action

Klaus Lucke (Bremen, Germany) The use of silicone oil for complex retinal detachments was developed primarily in Europe in the 70’s and 80’s. While there is widespread agreement on its advantages, to this day the mechanisms of action are not entirely understood and remain in part hypothetical. Recent developments such as the use of heavy oils, however, have shed some light on the mechanisms behind the beneficial effects of silicone...

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Anti-VEGF Monotherapy for Exudative ARMD Presenting with Concomitant Hemorrhages

http://www.evrs.eu/medias/2010/congress/Hemorrhages.flv Silvia Bopp, Andreas Schüler, Klaus Lucke (Bremen, Germany) Advantages:  To investigate the role of sub-retinal hemorrhages in exudative ARMD and investigate, if the hemorrhagic component influences the outcomes under continuous anti-VEGF therapy. Methods: Retrospective chart review of 30 patients presenting with exudative ARMD and concurrent sub-retinal hemorrhage of 2 disc...

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Surgical Approach to Peripheral Exudative Hemorrhagic Chorioretinopathy (PEHCR) with Macular Detachment

http://www.evrs.eu/medias/2010/congress/Non-Age-Related-Macular-Degeneration-Nor-Diabetes-Neovascularization.flv Alexandra Brix, Klaus Lucke (Bremen, Germany) Advantages: To describe PEHCR, a not so rare condition in the elderly. It is often only an accidental finding without functional or therapeutic consequences. There is surprisingly little literature on the condition which has been given a variety of names such as for instance...

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Surgical Approach to Advanced Coats Disease

http://www.evrs.eu/medias/2010/congress/Vascular-Pathologies-in-Young-Patients.flv Klaus Lucke, Silvia Bopp (Bremen, Germany) Advantages: To describe surgical procedures and overall relatively good outcomes in advanced cases of Coats’ disease with traction retinal detachment, subretinal exsudation and frequently pucker formation in eyes that unoperated would eventually end up blind. Methods: The charts of 17 eyes of 16 patients with...

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Visco-Protection of Macular Holes During ICG-Guided ILM-Peeling

http://www.evrs.eu/medias/2009/congress/Controversial-Techniques.flv Authors: Silvia Bopp, Klaus Lucke, Andreas Schüler, Bremen, Germany Advantages: To protect RPE from potential ICG-toxicity in MHS and enhance visual outcomes. Methods: Recent data supports that ICG is potentially harmful to the neuroetina and RPE. Presumed mechanisms include direct tissue toxicity and enhanced light absorption (phototoxicity). In addition, ICG seems to...

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Primary Pars Plana Vitrectomy without an Encircling Band for Rhegmatogenous Retinal Detachment

http://www.evrs.eu/medias/2009/congress/Systematic-Primary-Pars-Plana-Vitrectomy-vs-Only-in-Selected-Cases.flv Authors: Silvia Bopp, Klaus Lucke, Bremen, Germany Advantages: Primary vitrectomy without additional buckle is equal effective and the more patient-oriented method. Methods: The conventional approach to retinal detachment includes vitrectomy in combination with scleral buckling and is considered safe and effective. Major...

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There Could Still Be a Place for Surgical CNV Removal

http://www.evrs.eu/medias/2009/congress/Surgery.flv Author: Klaus Lucke, Bremen, Germany Introduction: Surgical removal of subfoveal CNVs was practiced widely in the 1990s for the treatment of AMD and other exudative maculopathies. Since it virtually always left a large subfoveal RPE defect the visual results were by and large disappointing and the Submacular Surgery Trial (SST) showed that no statistically significant improvement in vision...

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Can You Hear the Vitreous?

http://www.evrs.eu/medias/2009/congress/How-to-Reduce-Complications.flv Author: Klaus Lucke, Bremen, Germany Flow control and audio feedback puts you back in charge Vitrectomy near the retina, particularly a mobile one, remains the big challenge in vitreoretinal surgery. Removing the vitreous in the vitreous base effectively brings on the danger of cutting into the retina inadvertently. The fact that vitreous generally is transparent adds...

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2009 RETINAWS – Pupilary Block from Gas in AC

http://www.evrs.eu/medias/2009/videos/Pupilary-Block-from-Gas-in-AC.flv

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2009 RETINAWS – Emulsified Heavy Oil

http://www.evrs.eu/medias/2009/videos/Emulsified-Heavy-Oil.flv

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2009 RETINAWS – Trying Off Von Hippel Angionoma

http://www.evrs.eu/medias/2009/videos/Trying-Off-Von-Hippel-Angionoma.flv

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A Case against Transconjunctival Surgery

http://www.evrs.eu/medias/2009/congress/20-Gauge-23-Gauge-25-Gauge.flv Author: Klaus Lucke, Bremen, Germany More than six years ago 25g sutureless transconjunctival surgery was introduced to the ophthalmic world with the stated advantage that the thin diameter of the instruments allowed sutureless sclerotomies, thereby resulting in a much increased perioperative patient comfort. A number of disadvantages were surprisingly readily accepted...

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ILM-Peeling for Pucker Prophylaxis

http://www.evrs.eu/medias/2008/congress/ILM-Peeling-for-Pucker-Prophylaxis.flv Klaus Lucke, Silvia Bopp (Augenklinik Universitätsallee, Bremen, Germany) Advantages: The incidence of pucker formation after retinal detachment surgery has been reported at between 4% and 25%. When it occurs it frequently is a functionally devastating event. Since rhegmatogenous detachment in our hands is treated by vitrectomy without buckling in most cases we...

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Vitrectomy Combined with Refractive Lens Exchange

http://www.evrs.eu/medias/2008/congress/Vitrectomy-Combined-with-Refractive-Lens-Exchange.flv Klaus Lucke, Silvia Bopp (Augenklinik Universitätsallee, Bremen, Germany) Advantages: The question whether refractive lens exchange might increase the risk of retinal detachment in myopic eyes is still discussed controversially. Since combined anterior/posterior segment surgery is routine procedure in our hands, and since the vitreous is usually...

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Atramatic Approach to Submacular Hemorrhage

http://www.evrs.eu/medias/2008/congress/Atramatic-Approach-to-Submacular-Hemorrhage.flv Silvia Bopp, Klaus Lucke (Augenklinik Universitaetsallee, Bremen, Germany) Advantages: To protect the fovea from severe toxic damage due to submacular hemorrhage and avoiding subretinal surgical manipulations. Methods: Indications for surgery are fresh subfoveal hemorrhages due to exudative macular degeneration (ARMD) or ruptured retinal arterial...

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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 – Silicone

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

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Vitrectomy Session – Infusion Line

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

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Optic Pit Retinal Detachments – Attempt at a Unifying Theory

Klaus Lucke, MB ChB (Bremen, Germany), Silvia Bopp, MD (Bremen, Germany) PURPOSE: The pathogenesis of optic pit retinal detachments, particularly the source of the subretinal fluid continues to be controversial. Vitreous traction, full thickness retinal defects or a communication channel to the subarachnoid space have been proposed. The purpose of this paper is to present a collection of instructive cases which suggest a diversity of...

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Cataract Surgery from the Viewpoint of a Vitreoretinal Surgeon

http://www.evrs.eu/medias/2006/videos/Cataract-Surgery-from-the-Viewpoint-of-a-Vitreoretinal-Surgeon.flv Klaus Lucke, MB ChB (Bremen, Germany) SYNOPSIS The film describes the considerations a vitreo-retinal surgeon would entertain in the choice of IOL and cataract surgical technique if he were to give advice to a cataract surgeon. Aspects under review are the significance of capsular opacification, IOL material and design of optic and...

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Cataract Surgery from the Viewpoint of a Vitreoretinal Surgeon

Cataract Surgery from the Viewpoint of a Vitreoretinal Surgeon

Klaus Lucke, MB ChB (Bremen, Germany) SYNOPSIS The film describes the considerations a vitreo-retinal surgeon would entertain in the choice of IOL and cataract surgical technique if he were to give advice to a cataract surgeon. Aspects under review are the significance of capsular opacification, IOL material and design of optic and haptics and their effect on subsequent vitreoretinal surgery. ...

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Expression of VEGF and Endostatin in Human Choroidal Neovascular Membranes Following Verteporfin Photodynamic Therapy

Salvatore Grisanti, MD (Tuebingen, Germany), Olcay Tatar, MD (Tuebingen, Germany), Kei Shinoda, MD, PhD (Tokyo, Japan), Annemarie Adam, (Tuebingen, Germany), Klaus Lucke, MB ChB (Bremen, Germany), Claus Eckardt, MD (Frankfurt, Germany), Peter Stalmans, MD, PhD (Leuven, Belgium), Tillmann Eckert, MD (Frankfurt, Germany), Silvia Bopp, MD (Bremen, Germany), Karl Ulrich Bartz-Schmidt (Tuebingen, Germany) PURPOSE: To evaluate the impact of...

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An Update on Macular Rotation Surgery for Large Subretinal Neovascular Membranes

Klaus Lucke, Bianca Kemper, Katrin Böhm – Augenklinik Universitätsallee, Bremen, Germany Purpose: Macular rotation surgery for age related macular degeneration has now been performed for more than 6 years as a regular and routine intervention in a few centers particularly in Europe. In our institution more than 350 such operations have been performed by now. Due to considerable advances in the surgical technique used the time for each...

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Surgery for Age-Related Macular Degeneration Complicated by Massive Subretinal Hemorrhage

Nataliya Nehus, Klaus Lucke – Augenklinik Universitätsallee, Bremen, Germany Purpose: Eyes with massive subretinal hemorrhage complicating advanced age related macular degeneration are known to have a very poor functional prognosis. Surgical management is extremely difficult and consequently very rarely undertaken. The aim of this study is to evaluate the anatomic and functional outcomes in a group of patients in which surgery for such a...

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Intravitreal Triamcinolone Application in Diabetic Eyes: Rationales, Indications and Mode of Action

Silvia Bopp, MD, Klaus Lucke, MB ChB, Augenklinik Universitätsallee, Bremen, Germany Purpose: To demonstrate possible indications for intravitreal triamcinolone acetonide (TA) injections in diabetic eyes, and to contribute to the understanding of triamcinolone-induced resolution of diabetic macular edema. Introduction: Corticosteroids show a broad spectrum of pharmacologic effects, such as anti-inflammatory/anti-edematous, angiostatic and...

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Technique of Localized en-Bloc Dissection along Natural Lines of Cleavage in Diabetic Traction Detachment

Klaus Lucke, MB ChB, Silvia Bopp, MD, Augenklinik Universitätsallee, Bremen, Germany Purpose: To demonstrate a little known surgical approach to diabetic traction detachment utilizing the natural lines of cleavage between neurosensory retina and proliferative tissue to achieve separation by blunt dissection with a simple curved spatula. Introduction: Diabetic traction detachment frequently constitutes a formidable surgical challenge....

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Secondary Interventions after Posterior Segment Trauma

Silvia Bopp*, Klaus Lucke Germany Purpose: The present paper highlights the sequences of interventions that may follow primary trauma care and indicates on secondary complications, such as PVR, hypotony and sympathetic ophthalmia. Treatment modalities and the significance for the anatomic and functional outcome are presented. Introduction: Despite of the advances in vitreoretinal techniques, visual prognosis in eyes with open globe injuries...

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Retinotomies and Retinectomies: How and When?

Silvia Bopp,MD*, Klaus Lucke,MD Tagesklinik Universitätsallee, Bremen Purpose: The present review emphasizes indications and surgical techniques for retinotomies/retinectomies. Introduction: Retinotomies and Retinectomies are extreme surgical maneuvers for complex situations, in which vitrectomy and peeling techniques prove insufficient to achieve retinal reattachment. Major indications are severe postoperative and posttraumatic PVR, but...

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ICG-Staining and ILM-Peeling in Proliferative Vitreoretinopathy

Klaus Lucke*, Silvia Bopp, Tagesklinik Universitätsallee, Bremen, Germany Purpose: Peeling of the internal limiting membrane (ILM) of the retina has become technically easy by the introduction of intraoperative staining with ICG and is being performed routinely in macular hole surgery by most vitreoretinal surgeons. In retinal detachment the ILM frequently seems to contract as demonstrated by the sand dune phenomenon. In PVR detachments...

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Combined Cataract Operation and Vitrectomy – Experience in More than 3000 Cases

Klaus Lucke Bremen, Germany There are many arguments why combined cataract surgery and vitrectomy should possibly be avoided. It constitutes more difficult surgery, there is an increased risk of peri-operative fibrin formation and then there is the fear of postoperative rubeosis iridis, neovascular glaucoma or keratopathy. As a result the older strategy in vitreoretinal surgery consisted of leaving the lens whenever possible and removing it...

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Cataract Surgery from the Viewpoint of a Vitreoretinal Surgeon

Klaus Lucke Bremen, Germany Effective communication between anterior and posterior segment surgeons is often sadly lacking. Cataract surgeons frequently operate without much thought as to the possible consequences of their approach for the posterior segment and posterior segment surgeons in many places still frequently perform a pars-plana lensectomy without considering the optical complications of their procedure. The advances in...

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Retinotomies and Retinectomies: How and When?

S. Bopp, K. Lucke Bremen, Germany Introduction: Retinotomies and Retinectomies are surgical maneuvers for complex situations, in which conventional vitrectomy and peeling techniques prove insufficient to achieve retinal reattachment. Advanced forms of PVR including posterior segment trauma, but also complications secondary to vasoproliferative diseases are the major indications. Benefits and severe potential risks of retinoplastic...

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ILM Peeling in PVR

Klaus Lucke, Silvia Bopp Bremen, Germany Peeling of the internal limiting membrane of the retina has become technically easy by the introduction of intraoperative staining with ICG and is being performed routinely by most vitreoretinal surgeons in macular hole surgery. This technique is furthermore under investigation for the treatment of macular edema in diabetic maculopathy and cystoid macular edema secondary to uveitis and other...

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General Anesthesia in Vitreoretinal Surgery

Klaus Lucke, Silvia Bopp, Hermann Eilers Bremen, Germany Anesthesia constitutes a special challenge in vitreoretinal surgery since a disproportionate number of our patients are old and in bad general health. In our series 40% of patients are 70 years or older, 62% are hypertonic, 37% have coronary heart disease, 35% cardiac insufficiency and 35% obstructive or restrictive lung disease. 23% have diabetes mellitus and about 33% are classified...

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Super Wide Field BIOM

Klaus Lucke, Silvia Bopp Bremen, Germany While originally vitrectomy procedures took place largely in the premacular area, in recent years vitreoretinal surgeons place an increasing emphasis on thoroughly dealing with all problems in the vitreous base as well. This includes traction phenomena in anterior PVR and primary vitrectomy for retinal detachment, as well as pathological changes such as Coat´s disease and angiomatous lesions, which...

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Free Choice Between Venturi and Flow Control

Klaus Lucke, Silvia Bopp Bremen, Germany Venturi vacuum systems have become the gold standard in vitrectomy machines, due to their rapid and linear response to foot pedal depression. However, in close proximity to the retina they constitute a high risk as uncontrolled flow can result in inadvertent engagement of retinal tissue resulting in unwanted tear formation. High speed shaving systems have been developed to control the flow, however...

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