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Safety and Stability of Plate-haptics IOL (CT Asphina 409M/MP) in Combined Phacovitrectom

Abdallah A Ellabban, Atiq A Babar, Mark T Costen, UK Purpose: There is a growing trend toward performing combined phacovitrectomy for various indications; however, there is no specially designed IOL for combined surgery. This study aims to assess the safety and stability of plate-haptics CT Asphina 409M/MP IOL (Carl Zeiss Meditec, Germany) in combined phacovitrectomy. Setting: Prospective interventional case series. Methods: Combined...

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Automated Direct Perfluorocarbon Liquid / Silicone Oil Exchange: Tips for Improved Success in Complex Retinal Surgery

Abdallah A Ellabban, Ahmed B Sallam, UK Purpose: To describe a simple method for automated direct silicon oil injection and active PFCL aspiration using 23-g vitrectomy system. Methods: First, the oil syringe is connected to the 3-way cannula. The infusion is taken off the eye and primed with oil. The extrusion line is connected to an aspiration cannula for active extrusion. The automated injection/extrusion mode is activated in the...

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Multimodal Imaging in Macular Diseases

Ahmed Sallam, USA, Abdallah Ellabban, United Kingdom & Zofia Michalewska, Poland Multimodal imaging is rapidly evolving, providing unprecedented in-vivo information on the microstructural changes of the retina, and becoming an indispensable tool in the diagnosis and management of many retinal disorders. This course will focus on practical tips that help busy clinicians in making treatment decisions when managing retinal diseases...

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Central Retinal Artery Occlusion During Vitrectomy: Immediate Retinal Revascularization Following Induction of Posterior Vitreous Detachment

ABSTRACT Purpose: To describe a patient with acute central retinal artery occlusion (CRAO) during vitrectomy surgery and the possible role of vitrectomy in acute CRAO management. Methods: An 84-year-old man presented with broad vitreomacular traction and epiretinal membrane in the right eye. Preoperative assessment clearly showed normal retinal vasculature. On starting vitrectomy, complete CRAO with marked segmentation of all retinal...

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OCT-guided Induction of Posterior Vitreous Detachment for Firmly Adherent Posterior Hyaloid in Macular Surgery

ABSTRACT Purpose: Surgical Induction of posterior vitreous detachment (PVD) is an important step in vitreoretinal surgery. In some cases, it can be traumatic due to firm attachment of the posterior hyaloid to the disc, particularly when vitrectomy is performed in a young patient with adherent hyaloid or with small gauge cutters, which often require high suction levels to induce PVD. This can be complicated by retinal nerve fiber layer...

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Vitrectomy Dyes: The Blues of Vitrectomy !

Many surgeons use dyes during vitrectomy surgery to enhance visualization of intraocular structures such as vitreous, epiretinal membranes and internal limiting (ILM). Several dyes are employed for this purpose including trypan blue, brilliant peel, indocyanin green and some newer Lutein based dyes. Triamcinolone is also used to improve the visualization of the vitreous gel and the posterior hyaloid. In this presentation, we aim to...

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Floaters Surgery

Vitreous floaters could result from vitreous seneresis or as result of vitreoretinal diseases such as intraocular inflammation or vitreous haemorrhage. In the absence of associated vitreoretinal disease, most patients with vitreous seneresis- related floaters learn to live with their symptoms. However, surgery is justifiable in some patients whose quality of vision is compromised because of significant floaters. It is important to carefully...

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Surgical PVD Induction Using Combined Sharp Pick and Active Aspiration

Some cases of retinal detachment particualry in young phakic patients, may not have posterior vitreous detachment (PVD). If operated by PPV, induction of PVD in these cases is mandatory. However, PVD induction by active aspiration of the vitreous cortex over the optic disc margin as usually employed in PPV surgery can be challenging in these eyes because of firmly adherent posterior hyaloid and the absence of counter traction from the...

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In Combined Phaco-vitrectomy, Choose the Lens that Offers Best Intra- and Post-operative Stability

In combined phaco-vitrectomy surgery, our preferred choice is CT Asphina IOL (Carl Zeiss Meditec, Germany). The IOL has excellent stability and centration profile in the bag. It tolerates well anterior chamber fluctuations throughout the surgery. There is no edge between haptic and optics, allowing for good peripheral visualisation with minimal aberrations. Additionally, it can be inserted via 2 mm incision; therefore usually no suture...

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Retinal Detachment Surgery Needs to Be Individualized – Vitrectomy Surgery Is Not the “One Size Fits All™” Treatment

Rhegmatogenous retinal detachment (RD) surgery is the most common indication for vitreoretinal surgery. Pars plana vitrectomy (PPV) and scleral buckle (SB) are the most commonly used techniques, with the proportion of patients undergoing SB significantly decreased over the last decade in the US and worldwide. There is agreement that PPV is the surgery of choice for complex RD and in pseudopakic eyes. However, SB remains a valid option for...

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Endophthalmitis – Immediate Intravitreal Antibiotic Therapy Only is What We Should Do

The Endophthalmitis Vitrectomy Study (EVS) has recommended that intravitreal antibiotics should be the ‘‘standard of care’’ for acute endophthalmitis occurring after cataract surgery and that the benefit of early vitrectomy surgery is limited. However, with recent advances in vitrectomy surgery techniques, there has been an increased interest in performing early vitrectomy surgery to treat endophthalmitis in...

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Microstructural Changes Depicted by OCT in DME: Insight into Pathomorphology and Tailored Management

The introduction of OCT and intravitreal pharmacotherapy has revolutionized the management of diabetic macular edema (DME). So far, central retinal thickness (CRT) is the most commonly used measure to quantify DME in randomized controlled trials and by retinal physicians in clinical practice. However, various studies showed that CRT has a modest correlation with visual acuity in DME and this relation is sometimes paradoxical. This...

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Focal Choroidal Excavation in Eyes with CSCR

Purpose: To study the prevalence and three-dimensional (3-D) tomographic features of focal choroidal excavations in eyes with central serous chorioretinopathy (CSC) using swept-source optical coherence tomography (OCT). Design: Prospective, cross-sectional study. Methods: We examined 116 consecutive eyes with CSC with a prototype 3-D swept-source OCT. 3-D images of the shape of the macular area, covering 6 x 6 mm2, were reconstructed by...

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