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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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Opacification of Hydrophilic Acrylic IOLs Following Pars Plana Vitrectomy

ABSTRACT IOL opacification as a result of superficial calcification in the pupillary area has first been described after corneal surgery, especially after DMEK- or DSAEK procedures with intracameral air or gas application. Single case reports with a similar IOL opacification pattern after vitrectomy with gas or silicone oil tamponade have been published. A common feature is that only hydrophilic acrylic IOLs are affected. We present a...

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Complex Macular Holes: Does Simple Vitrectomy and ILM Peeling also Work?

ABSTRACT MHS (macular hole surgery) with dye-assisted ILM-peeling is a standard procedure to treat idiopathic MHs leading to high anatomic success rates and good functional outcomes. Prognosis in case of MHs with preexisting pathologies that affect the retina or RPE, however, is uncertain. The current paper demonstrates a consecutive clinical series of atypical or secondary macular holes with coexisting retinal pathologies, such as MacTel...

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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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Endophthalmitis After Intravitreal Drug Injection – A Transatlantic Controversy Regarding Prophylaxis and Treatment

Intravitreal drug application (IVI) has become the most frequent invasive intraocular procedure. Endophthalmitis – although rare with an incidence of 0,04% per injection – is the most devastated complication. Looking back to the initial era of IVI, infectious rates were as high as after cataract surgery. In face of a significant increased individual cumulative risk, antiseptic measures have been introduced and resulted in a marked...

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Retinal Folds After Vitrectomy for RD: Pitfalls During Revision Surgery

Problem: Intraoperatively, an unintended shift of subretinal fluid remnants (SRF) towards the posterior pole during fluid-gas exchange may result in a retinal fold. It occurs at the border between previously detached and attached retina. If the border goes through the macula, a macular fold occurs and patients suffer from visual deterioration and severe metamorphosia. If the border is inferior to the macula, the macula may be flat, but is...

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Sub-foveal PFCL: Careful and Easy Removal

Problem: Subfoveal PFCL is usually observed after vitrectomy for macula-off retinal detachment. As it causes photoreceptor cell damage and visual impairment, removal as early as possible is generally recommended. Most frequently, during repeat vitrectomy, a direct puncture of the bleb using a small-sized cannula (for example with a 40G teflon needle) is performed. H owever this manoeuvre implies the risk to damage the juxtafoveal retinal...

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Endophthalmitis After Intravitreal Drug Application

The Problem: Endophthalmitis after intravitreal injection of anti-VEGF or steroids has a poor prognosis even if treatment is performed timely. No guidelines exist with regard to the therapeutic regime, but most surgeons agree upon vitrectomy with intravitreal antibiotics ± systemic antibiotic therapy. Case Presentations: From 2005 until now, we have performed 28800 intravitreal injections and experienced 3 culture-proven cases with...

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Routine ILM Peeling for Macula-on & Macular-off RRD: New Data on Functional Outcomes

Media not available due to technical recording problems. EVRS is very sorry for the inconvenience.   Advantages: To analyze functional limits und subjective disturbances despite of anatomically successful surgery for rhegmatogenous retinal detachment (RRD). Methods: 138 eyes with rhegmatogenous retinal detachment (RRD) were studied. Among others, analysis included VA measurement, recording of subjective VA disturbances, binocularity...

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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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Voriconazole, but not Amphothericin B for Primary Treatment of Fungal Endophthalmitis

SCIENTIFIC POSTER_Martin Kopietz Advantages: Fungal endophthalmitis is a rarer and sight-threateining condition, which is difficult to treat. Standard medication for an acute mycotic infection is amphothericin B, which can be given topically, intravitreally and systemically. This drug carries serious side effects, especially due to its local and systemic toxicity. Voriconazole, a second-generation synthetic fluconazole-derivate (triazole)...

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Course 2014: Pathologic Myopia

Definition of pathologic myopia (syn. degenerative myopia) is not uniform. From the view­point of the clinician, axial myopia associated with structural changes of the posterior globe describes the condition most properly, as these alterations may threaten visual acuity. Refraction errors greater than 8 diopters are frequently associated with visual dysfunction. The prevalence of high myopia is apparently increasing, particularly in some...

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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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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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Various Dyes for ILM Peeling

Advantages: To review current visualization aids for VR surgery with respect to their specific features and clinical applications. Furthermore, to correlate the various staining patterns with the underlying pathology. Methods: ICG, trypan blue, brilliant blue and the combination trypan blue/brilliant blue as well as triamcinolone serve for visualization of the vitreous, proliferative vascular and non-vascular epiretinale membranes and the...

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Management of Choroidal Neovascularisation in Best’s Disease

Purpose:   Review of the management of choroidal neovascularisation secondary to Best’s vitelliform macular dystrophy. Materials and methods: Eight eyes of 6 patients with Best’s disease complicated by choroidal neovascularization (CNV) were included. The visual acuity, angiographic and optical coherence tomography (OCT) findings were used to assess management outcome.  All patients presented with reduction in visual acuity.  Two...

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Pathologic Myopia

Silvia Bopp (Bremen, Germany) Definition of pathologic myopia (syn. degenerative myopia) is not uniform. From the view­point of the clinician, axial myopia associated with structural changes of the posterior globe describes the condition most properly, as these alterations may threaten visual acuity. Refraction error greater than 8 diopters is frequently associated with visual dysfunction. The prevalence of high myopia is apparently...

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Pediatric Rhegmatogenous Retinal Detachment: Etiology and Surgical Outcomes

Silvia Bopp (Bremen, Germany) Advantages: To evaluate the etiologies, treatment and surgical outcomes of rhegmatogenous retinal detachment (RRD) in children and adolescents (up to 18 years) and to highlight the specific features that are different from adult RRD. Methods: Retrospective chart review of 55 eyes (50 patients) with RRD between 2000 and 2010. Only 10 eyes showed RRD without any identifiable risk factor (idiopathic). The...

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Retinal Redetachment After Silicone Oil Removal

Silvia Bopp (Bremen, Germany) Advantages: To address the problem of retinal redetachments after silicone oil removal in eyes that had undergone vitreous surgery with silicone oil tamponade for complicated rhegmatogenous retinal detachment (RRD) and proliferative vitreoretinopathy (PVR). Methods: Retrospective chart review of 73 patients who had vitrectomy / silicone oil tamponade and consecutive oil removal between 2007-2010. Data...

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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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Pathologic Myopia

Silvia Bopp (Bremen, Germany) Definition of pathologic myopia (syn. degenerative myopia) is not uniform. From the view­point of the clinician, axial myopia associated with structural changes of the posterior globe describes the condition most properly, as these alterations may threaten visual acuity. Refraction error greater than 8 diopters are frequently associated with visual dysfunction. As the prevalence of high myopia is apparently...

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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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Vitrectomy, Dye–Assisted Peeling and Gas Tamponade for Staphyloma–Associated Retinal Detachment

http://www.evrs.eu/medias/2009/congress/High-Myopia.flv Author: Silvia Bopp, Bremen, Germany Advantages: To question routine application of silicone oil in highly myopic eyes with posterior retinal detachment with posterior retinal detachment and to support meticulous peeling / gas as a first –line approach. Methods: An imbalance between the retina and the choroid-sclera complex associated with axial elongation and posterior staphyloma...

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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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Fundus Obscuring Vitreous Hemorrhage of Indeterminate Origin: Rationales for Early Timing of Surgery

http://www.evrs.eu/medias/2009/congress/Hemorrhages.flv Author: Silvia Bopp, Bremen, Germany Advantages: To encourage early vitrectomy for vitreous hemorrhage to prevent retinal detachment and PVR. Methods: Causes for fundus-obscuring vitreous hemorrhage are manifold. Therefore, waiting for spontaneous resolution and interfering only in case of vision-threatening complications, such as retinal detachment, is commonly advocated. Due to the...

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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 – Hemorrhages

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

http://www.evrs.eu/medias/2007/videos/vitrectomysession-installation.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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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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PFV: Clinical Spectrum and Therapeutic Approach

Silvia Bopp, MD (Bremen, Germany) PURPOSE: Persistent fetal vasculature syndrome (PFS) or persistent hyperplastic primary vitreous (PHPV) shows a broad clinical spectrum that ranges from mild asymptomatic changes to severe blinding alterations. The paper illustrates the clinical spectrum in order to contribute to the understanding of PFS and to stimulate discussion about therapeutic options for selected cases. METHODS: Cases were selected...

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Visualization Aids in VR Interface Disorders: What Does the Staining Pattern Tell Us?

S. Bopp Purpose: To present different staining patterns in various macular diseases and discuss their significance with respect to the underlying pathology. Introduction: Ophthalmoscopically, many cases designed for macular surgery show subtle clinical findings that may be difficult to interpret. OCT has shown to be a valuable tool in planning the surgical strategy, and visualization aids allow meticulous surgery in...

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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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Posterior IOL-Luxation: Characteristics, Surgical Approach and Current Treatment Controversies

Silvia Bopp Bremen, Germany Introduction: Posterior dislocation of IOLs in the era of phaco/in-the-bag implantation is a rare complication. The leading symptom is sudden visual loss due to optic “aphakia”. Treatment is recommended firstly for the patient’s visual rehabilitation and secondly to prevent late complications. Although clear scientific data is lacking, it is generally assumed, that the mobile intravitreal...

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Capsular Block Syndrome with Hydrorupture Can Mimic Expulsive Hemorrhage

Silvia Bopp Bremen, Germany Introduction: Sudden hardening of the globe and flattening of the anterior chamber during cataract surgery is highly suggestive of incipient expulsive hemorrhage. In the era of small incision cataract surgery and self sealing wound incisions, dreadful consequences of expulsive choroidal detachment, such as extrusion of intraocular tissue, fortunately rarely occur. This report is on 2 patients with suspected...

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Current Concepts in Postoperative Endophthalmitis

Silvia Bopp Bremen, Germany Acute postoperative endophthalmitis is the most important emergency situation in Ophthalmology. Inflammatory cells, lytic enzymes and bacterial toxins can destroy the retina irreversibly within hours. Despite of efficient treatment modalities, risk of blindness is still 15%. Immediate therapy is indicated, but treatment modalities are still under debate. The EVS-study has given evidence-based guidelines for early...

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Posterior Luxation of a Capsular Tension Ring: Case Report & Indications/Contraindications for CTR-implantation

Silvia Bopp Bremen, Germany Introduction: Implantation of a capsular tension rings (CTR) in eyes with radial capsular tears and posterior capsular defects are wrong indications in view of the risk that posterior luxation of the CTR can occur. Vitreoretinal surgery for removal of the large, rigid intravitreal foreign body is recommended, if additional complications are present. Case report: A 72-year old male patient presented with...

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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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Vitreoretinal Surgery after Implantation of Multifocal Lenses

Silvia Bopp Bremen, Germany Abstract not written by the author

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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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