European VitreoRetinal Society a certain philosophy

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Purpose: To review consecutive retinal detachments repaired with PR over a recent three year period and compare the outcome of failed cases regarding final anatomic success, final visual acuity and overall cost versus eyes successfully repaired with one operation. Regarding retinal detachment repair, CMS has determined single operation success (SOS), not visual recovery, will be used as the primary parameter to measure quality of care and...

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This 6-year-old boy suffered a rupture due to a fall. He underwent vitrectomy only a few weeks after the trauma because he was not referred on time. Even then, the posterior vitreous could not be detached, and PVR duly developed. During the reoperation a 360º retinectomy was performed, but the PVD could still not be accomplished. The retina redetached under silicone oil, with some proliferation centrally. This time the proliferative...

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My mistake: I ignored the subretinal band because the surgery went on smoothly with proper retinal reattachment under heavy liquid. after performing a heavy liquid/ air exchange I observed a pocket of posterior subretinal fluid in the nasal part of the retina at the subretinal band area. I ignored this observation and injected silicone oil with the rationale that this is an isolated pocket of fluid that will be spontaneously absorbed by...

Purpose: The purpose of this work is to report the injection of subretinal trypan blue to identify occult retinal breaks during vitrectomy for rhegmatogenous retinal detachment (RRD) repair. Methods: Case report of a patient with RRD in whom the causative retinal break could not be found during surgery, even after scleral indentation. Trypan blue 0.15% was injected into the peripheral subretinal space using a 39 g cannula after injection...

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Bleeding during Retinectomy in PVR bleeding during Retinectomy maybe due to: insufficient diathermy for the retinectomy area especially if it is done posteriorly OR rarely a direct choroidal injury at areas of retinochoroidal adhesion e.g scar bleeding is avoided by proper meticulous diathermy of the intended area, especially at terminal branches of retinal vessels. To do the retinectomy as peripheral as possible. Cautious management of...

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The Aspheric Macular Contact Lens provides superb visualization of the macula. However, the field of view is 30 degrees. Sometimes, I need to tilt the lens slightly to one side of the cornea to see a wider area of the macula. In certain situations the contact lens alone is not sufficient for complete macular maneuver. These include: wide extensive epimacular membranes, and small pupil. My Strategy is so simple: I try to use the contact...

Posterior hyaloid was tightly attached to retina and could not detach it with vacuum. I tried to engage the posterior hyaloid with a pick. However, triamcinolone blocked my view and I engaged the retina and tear the retina in the papillomacular bundle area. Contact Details: Email: sozdek@gazi.edu.tr Cell Phone:...

Introduction: In case of magnetic foreign body my safety exit technique is to use always a magnet to immobilize the foreign body that fluctuates in the vitreous or that is stucked on the retina and contemporarily to grab it with a Machmer diamond dusted forceps. More over the magnet allows you to turn the foreign body in the best position for its extraction. In this case you can reduce to the minimum the opening for the extraction both in...

A myopic foveoschisis case 78 year-old high myopic female (-13.00D) with foveoschisis. This video demonstrates the unexpected iatrogenic retinal hemorrhage caused by ILM forceps trauma. Considering long eyeball length of highly myopic eye, the actual forceps length is too short for 25G plus system developed by Alcon. When trying to approach to the macula with 25G plus ILM forceps for high myopic eye, we should be careful of abrupt...

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In 2007 Sakaguchi-Oshima-Tano proposed a technique for the removal of the epiretinic membranes and of the vitreomacular traction, without performing vitrectomy, in order to avoid the development of cataract in young and aphakic patient. In this case we use only forceps to remove the membrane without using colorants or other kind of materials. During this technique, anyway the insertion of a Mini-invasive 25/27G forceps causes a loss of...

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Introduction: Vitreous hemorrhages during vitrectomy are not an uncommon event, particularly in diabetic patients. However, intraoperative vitreous hemorrhages resulting from conjunctival and/or episcleral hemorrhages, after the successful closure of 23G scleral ports, is a rare finding, never before experienced by our surgical team. The authors present the case of a young man undergoing vitrectomy for persistent vitreous haze, that had a...

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A patient underwent a 23g vitrectomy , PFCL assisted, laser retinopexy on the break followed by a fluid air exchange for a retinal detachment. During the removal of the trocars, some air entered the subconjuntival space, and some seconds later blood started to fill all the anterior chamber with a hypotonus globe. The question was : how to proceed? As it was impossible to see what was going in the posterior chamber, it was decided to...

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This presentation is about suprachoroidal infusion line in one 20G and one 23G vitrectomy setting. First thing to be done to avoid such a problem is to check the infusion cannula tip at the beginning. However, when you notice such a complication you will see different ways of solving this problem in this video. Contact Details: Email: sozdek@gazi.edu.tr Cell Phone:...

This video is on a retinal abrasion of the posterior pole during core vitrectomy done by one of our fellows caused by a chair movement of the fellow while she was in the vitreous with probes. Contact Details: Email: sozdek@gazi.edu.tr Cell Phone:...

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MH surgery remains one of the most frequently performed surgery. It is usually successful when performed earlier and when MH diameter does not exceed 500 um. There are several techniques used to ensure the success after MH surgery in long standing cases or big macular holes. There are techniques which use the instrument to put the edges of the hole closer. There are techniques of IOL flap implantation, which remain technically very...

Case of 74 year old woman with large macular hole. After the first operation with classical technique 23G MIVS PPV. Posterior Hyaloid removal, ILM blu staining assisted regulated SF6 endotamponade the hole was not closed and had also raised margins. Rejection of gas bubble and positioning tight for 7 days did not produced the hoped reattachment of the edges and the closure of the hole.Reoperation and tamponade with heavy silicone and...

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Pathologic myopic eyes are proned to have choroidal effusions during ocular surgeries. This case had macular hole related retinal detachment who had a previous vitrectomy without success. She was offered to have a macular buckling surgery and vitrectomy. A limited subretinal hemorrhage was noted at the beginning of the surgery. We stopped at that moment and observed the choroidal hemorrhage for 10 minutes. Since it did not tend to enlarge,...

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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Purpose: To describe a very rare complication in vitreo retinal surgery related with a Perfluorocarbon liquid (PFCL). Description: We present 4 cases in which we use PFCL, two of them (Retinal detachment with macula attached and dislocated IOL in vitreous cavity) passed from 20/20 VA to hand movements and a severe central scotoma. All of them we could observe a severe atrophy in macular area with a complete disparition of retinal cell...

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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I present a case of emulsified silicone oil in the anterior chamber, which hides an underlying total cataract, and a very thick calcified anterior capsule and mild subluxation. I evacuated the emulsified silicone oil from the anterior chamber. and then i managed the calcified anterior capsule by fashioning an opening using a cannas scissors. I used a cautious divide and conquer Phacoemulsification for the cataract. After implanting the...

Currently, silicone oil tamponade is one of the most important and common stages in vitreous surgery. Also well -known negative effect of silicone oil on the corneal endothelium with its long stay contact. This is especially actual in cases of traumatic lesions of the eyeball when there is absolutely no iris-lens diaphragm or partially defect Zinns ligaments. Methods: In our work, we used the bandage sutures from “Mani”...

I will be presenting 2 cases of adherent silicone oil (1000cs) to the retina. In one patient, the silicone oil led to entrapment of heavy liquid fluid underneath the oil and that in turn led to foveal oedema and loss of central vision. The oil was removed 10 days later but the foveal vision never recovered. In the second patient, the adherent silicone oil was displaced and removed using a combination of heavy liquid fluid and fluid-air...

Phimosis in Recurrent PVR cases: challenges and timing of management I present 2 cases with capsular Phimosis. Phimosis elicit a contracted field of vision during vitreoretinal procedures. The ideal management is to perform a pre operative YAG enlargement of the phimosis. However, i had Phimosis in a 5 year old child, who isn’t cooperative enough for a YAG…. so i had to manage intra operatively. in the second case, i had an...

Introduction: Ocriplasmin is a truncated plasmin derivative, with vitreolytic enzymatic activity. Following the MIVI-TRUST study, it was approved as a therapeutic option for focal (<1500μm) VMT (Vitreomacular Traction), when accompanied by visual symptoms and/or a macular hole < 400μm. Although few complications have been reported, a few authors report on the unpredictability of the results of this treatment. The authors...

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Introduction: Intravitreal dexamethasone implants are currently an opti on for chronic macular edema due to diabetes, non-infectious uveitis and retinal vein occlusion. Anterior chamber migration is a rare event, occurring mostly in vitrectomized patients without posterior capsule integrity. This condition is associated with persistent corneal edema and ocular hypertension, therefore requiring intervention. The few cases published suggest...

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This is a case of posterior Dislocation of Intra ocular lens, with inadequate posterior capsular support . The retina was attached but there was fibrous tissue proliferation and picture of old Branch Retinal Vein occlusion. Priorities: either to retrieve the IOL to the anterior chamber level and keep till end of surgery then exchange. OR Explantation of the IOL at the beginning of the procedure then complete the vitrectomy, then implant....

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Strategic Difficulty: Explantation of the IOL at the beginning of the procedure via a large wound will disturb intra ocular fluid dynamics during the rest of the surgery. keeping the IOL tilted will obscure visualization of the posterior segment and the IOL may be dislocated posteriorly at any time during the procedure. My Option: I could readjust and relocate the 3 piece IOL into the anterior chamber level, and kept it centered so that i...

  Spontaneous dislocation of IOL and capsular tension ring complex is treated by simple suture fixation at 12 o\’clock. Vitrectomy is performed later to relieve any possible traction. Contact Details: Email: jerzy_n@poczta.onet.pl Cell Phone:...

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Management of posteriorly dislocated nucleus depends on the density of the cataract. relatively soft nuclei can be managed in situ, however dense nuclei need floatation into the anterior chamber, then either an anterior chamber phaco fragmentation is performed or the nucleus is delivered via a cornel/ corneoscleral wound. I present 2 cases: Case 1: Average density nuclear fragment. i performed a Bimanual mechanical manipulation and...

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A fourty seven years old lady who underwent Botulinium Toxin injection in the lids for cosmetic purpose . The drug was injected accidentaly inside the eye. >> What is the effect of intraocular injection of Botulinium Toxin . >> How to manage. This is going to be discussed in this case presentation. Contact Details: Email: mahavr@hotmail.com Cell Phone:...

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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...

Presentation shows two cases of choroidal neovascularisation after vitrectomy. Both cases undergo two surgical procedures. In first case the second procedure was performed to remove epiretinal membrane which causes macular edema. Second case was PVR detachment surgery treated in two operations. In first procedure we attached retina with silicone oil tamponade and 180 degrees retinectomy, and in second one we peel membranes and remove...

Prabu Baskaran_SCIENTIFIC POSTER 2015 We report an unusual catastrophic complication of Polypoidal Choroidal Vasculopathy (PCV) despite an initial satisfactory response to treatment. A 67 year-old female presented to us in July 2012 with defective vision in RE since six months. She was a known hypertensive and diabetic on treatment since 15 years. There was no history of trauma, blood dyscrasias or use of any anticoagulants. On examination,...

Objective: To study the effect and toxicity of oral Thalidomide on surgically induced PVR in rabbit eyes. Methods: The right eyes of 17 rabbits were operated to induce PVR by modified Iverson technique. Ten rabbits (Group T) received 400 mg/kg of oral Thalidomide for 4 days, while the other 7 rabbits were controls (Group C). Following weekly ophthalmoscopical examinations for 4 weeks, euthenasia and bilateral enucleation was performed. The...

Purpose: To report a case of a case of pseudomonas aeruginosa infection after scleral buckling in retinal detachment. Case Summary: A 68-year-old male presented with 2 day history of pain in the right eye. The patient had a history of scleral buckling for retinal detachment 10 years prior and excisional biopsy for conjunctival mass 1 month prior. Biopsy revealed chronic inflammation and granulation tissue formation. Slit lamp examinations...

Philippe Koch_SCIENTIFIC POSTER 2015 Introduction: To present the case of a 55 y.o. patient who developed an inadvertent silicone oil injection into the choroidal space during a vitrectomy for RRD and the resultant 5 y.o. follow-up. Case Presentation: A patient presented in 2010 with a LE rhegmatogenous retinal detachment extending from 9 to 7 o’clock, macula OFF. The causative break was a huge superior break extending from 10 to 3...

Vladimir Poposki_SCIENTIFIC POSTER 2015 Introduction: The endophthalmitis is a devastating complication of intravitreal injection (IVI) procedure. Topical antibiotics are used by consensus and protocol, because of supposed advantage of its use in the reduction of conjunctival bacterial growth. However, this benefit is controversial. Many studies concluded that they do not alter the incidence nor reduce the risk of endophthalmitis. Even...

Objective: To report on a case of iatrogenic retinal break (IRB) during a 25-gauge pars plana vitrectomy (PPV) surgery for the treatment of epiretinal membrane. Design: Case Report Methods: Edited video submission displaying the diagnosis and treatment of an unexpected complication during pars plana vitrectomy. Results: A 63 year old male was sent to our clinic following complaints of long-standing, progressive diminished visual acuity on...

Introduction: Vitreous haemorrhages during vitrectomy are not an uncommon event, particularly in diabetic patients. However, intraoperative vitreous haemorrhages resulting from conjunctival and/or episcleral haemorrhages, after the successful closure of 23G scleral ports, is a rare finding, never before experienced by our surgical team. The authors present the case of a young man undergoing vitrectomy for persistent vitreous haze that had...

Poster 2 Erkan Unsal Objective: To present a case, who developed phacogenic nongranulomatous uveitis and rhegmatogenous retinal detachment 2 years after complicated cataract surgery. Methods: The patient who was asymptomatic after a complicated cataract surgery for 2 years presented with rhegmatogenous retinal detachment. During the preoperative evaluation he developed sudden onset of uveitis resembling endophthalmitis. Nucleus fragments...

Poster Erkan Unsal Objective: To present a case who developed angle closure glaucoma with pupillary block 2 year after vitrectomy and silicone oil tamponade for giant retinal tear and detachment. Methods: 55-year-old phakic patient was applied to our outpatient clinic with the complaint of left vision loss. Best-corrected visual acuity was hand motion and intraocular pressure (IOP) was 14mmHg. Left retinal detachment was detected and a...

Poster David Martins Objective: Description of a clinical case with scientific interest. Introduction: Bilateral amaurosis is a rare complication of the treatment of Plasmodium falciparum malaria with quinine, and can occur with a single therapeutic dose in susceptible individuals. Visual acuity recovery usually occurs, with restricted visual field, but in a few cases amaurosis may be permanent, with optic atrophy. Case Study: 35...

Poster Youngduk Kim Purpose: To report three cases of macular hole formation in patients who was administered intravitreal ranibizumab. Method: The first case was a 72-year-old man with age related macular degeneration and vitreomacular adhesion. The second case was a 76-year-old woman with subretinal haemorrhage and high PED. She was diagnosed with ARMD. The third case was 51-year-old woman with subretinal haemorrhage and high myopia....

Purpose: Anti-VEGF injections have been standard treatment of exudative age-related macular degeneration (ARMD) in recent years. However multiple and recurrent injections needed to maintain the efficacy of the treatment may lead to adverse side effects related to this regimen. The aim of this study was to find out ocular adverse events associated with intravitreal injection of ranibizumab for the treatment of exudative ARMD performed in a...

Poster 2 Israel Gomez Sanchez Advantages: To evaluate the clinical findings and treatment outcomes in a patient with Branch retinal vein occlusion. Methods: To report a case of BRVO in a 60 years old patient, hypertensive who was treated, two days from diagnosis, with PPV and liberation of adventitia, with success. Two weeks afterwards developed a macular oedema, which was treated with a Dexamethasone intravitreal implant (Ozurdex ®)....

Poster Altan Goktas Purpose: To evaluate the effect of intravitreal ranibizumab injection on cardiac ischemic parameters and vascular endothelial function. Methods: This observational, prospective case series included a total of 48 patients (23 patients with age-related macular degeneration and 25 patients with diabetic macular edema). All participants received intravitreal injections of 0.5 mg ranibizumab. Cardiac ischemic parameters...

Poster Imen Ammous Purpose: To report incidence, risk factors and management of chronic elevated intraocular pressure (CEIOP) after silicone oil tamponade in complex retinal detachment. Patients & methods: A retrospective study of 170 cases (169 patients): 108 eyes with complex rhegmatogenous retinal detachment and 62 eyes with tractional diabetic retinal detachment. Pars plana vitrectomy with silicone oil tamponade was performed in...

Purpose: To evaluate the prevalence of retinal pigment epithelium (RPE) tears associated with anti-VEGF therapy and its relation with neovascular retinal pigment epithelial detachment (PED). Methods: A total of 226 patients with exudative age-related macular degeneration treated with intravitreal anti-VEGF were included retrospectively in the study. The presence of RPE tears; the effect of the presence, height, and duration of PED on the...

Twenty-three eyes with idiopathic macular hole, that failed to close following vitrectomy, were divided into 2 groups: Group 1 (9 eyes) that where operated upon by the author himself, and Group 2 (14 eyes) that were operated by other surgeons and referred to the author because of non-closure. Eyes in Group 1 are known to have undergone posterior hyaloid and ILM peeling. All eyes underwent OCT. The macular hole was found open, enlarged with...

Advantages: To present causes and surgical technique for reoperations in failed macular hole surgery in eyes previously operated with the inverted ILM flap technique. Methods: 11 eyes (6% of cases operated between 01.2008- 12.2011). During repeated surgery in all cases it was found that the inverted ILM flap reapproximated into its original position and did not close the macular hole. The ILM flap was put once again over the macular hole...

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...