European VitreoRetinal Society a certain philosophy

Full Thickness Macular Hole as a Complication of Idiopathic Parafoveal Telangiectasia A Spectral Domain OCT Analysis Laurence Lim Advantages: To document the macular changes in a patient with full thickness macular hole (FTMH) secondary to idiopathic parafoveal telangiectasia (IPFT) using spectral-domain optical coherence tomography (SD-OCT), and to propose possible mechanisms of FTMH formation. Methods: Fundus fluorescein angiography...

Purpose: To compare surgical outcomes with three dyes, brilliant blue G (BBG), triamcinolone (TA) and indocyanine green (ICG), used to facilitate internal limiting membrane peeling during macular hole surgery. Methods: This comparative, interventional cases series consisted of 30 eyes of 26 patients with senile idiopathic macular holes, who underwent 23 G vitrectomy with internal limiting membrane peeling. We compared the intraoperative...

Enlarged ILM Peeling in Idiopatic Macular Hole Surgery A Retrospective Study Claudia Bacalhau Objective: To evaluate the morphological and functional success of vitrectomy with enlarged internal limiting membrane peeling for full-thickness macular hole. Method: Retrospective study, including 18 patients with full-thickness macular hole that were submitted to vitrectomy with enlarged peeling of internal limiting membrane (until the...

Cystoid ME After Macular Hole Surgical Closure Claudia Bacalhau Objective: Description of a clinical case with scientific interest. Introduction: Macular hole surgery has now very high successful morphological and functional rates, with few postoperative complications associated. We describe a case with development of clinically significant macular edema treated effectively. Case Study: 65 year-old patient with full thickness macular...

Surgery is the common therapy for the macular hole and it usually achieves a good anatomic and a mild functional success. The procedure follows well-defined steps: central and peripheral 23 gauge pars plana vitrectomy, internal limiting membrane removal, air or air+gas (SF6 or CH3F8) or silicon oil tamponade. But the surgeons relating to their experience differently perform every step. While there are many reviews upon internal limiting...

Zofia Michalewska, Janusz Michalewski, Zofia Nawrocka, Jerzy Nawrocki (Lodz, Poland) Video documents a new theory of idiopathic non-full thickness macular holes based on spectral domain OCT (SD-OCT) observations and clinical appearance before and during surgery. It seems very probable that all these entities are caused by vitreoretinal traction, which produces local internal limiting membrane (ILM) defect in the fovea. These leads to...

M Nuñez, MP Mendivil, P Blasco, N Urrestarazu, L Ramos (Bilbao, Spain) Advantages: Parafoveal retinal holes after vitrectomy with peeling of the internal limiting membrane are an uncommon finding. The cause of this complication is still unknown. This case report presents a correlation between symptoms and retinal imaging. Case Report: A 50- year-old man with unremarkable medical and familiar history. The patient had been successfully...

Kubilhan Elmas, Özgür Bilen Basaran, Ali Altýnsoy (Ankara, Turkey) We reviewed the records of 17 consecutive patients (17 eyes) who underwent phacoemulsification and 23 gauge pars plana vitrectomy with ILM peeling in one session for repair of macular hole. The mean age of the patients was 66 (range 52 to 78) years. The mean duration of macular holes prior to surgery was 8 months. 12 holes closed, 5 remained opened. All patients except...

Antonio Ciardella (Bologna, Italy) Advantages: To report a particular appearance of the fundus, occasionally seen after removal of the internal limiting membrane (ILM). Methods: 56 eyes of 56 consecutive patients with an epiretinal membrane and 38 eyes of 36 consecutive patients with idiopathic macular hole, who underwent pars plana vitrectomy and ILM peeling. All patients received a complete ophthalmic examination, infrared (IR) and...

http://www.dailymotion.com/video/xnbees Zofia Michalewska, Janusz Michalewski, Zofia Nawrocka, Jerzy Nawrocki (Lodz, Poland) Video documents a new theory of idiopathic non-full thickness macular holes based on spectral domain OCT (SD-OCT) observations and clinical appearance before and during surgery. It seems very probable that all these entities are caused by vitreoretinal traction, which produces local internal limiting membrane (ILM)...

Yuksel Totan, Fatma Betul Aydogdu, Emre Guler (Ankara, Turkey) Advantages: To evaluate the surgical experiences with Brilliant blue G (BBG) staining of the inner limiting membrane (ILM) and the outcomes of BBG assisted macular hole surgery. Methods: In 10 patients with stage 3-4 idiopathic macular holes, BBG (Brilliant peel, Fluoron) was applied following complete posterior vitreous detachment on the macular surface under air conditions for...

SYMPOSIUM:MACULA POT POURRI Moderator: Khaled El-Rakhawy Sunday, June 19, 2005 An unusual large tractional macular break Author: S. Ben Yahia, S. Jenzeri, B. Jelliti, S. Aouafi, M. Oueld El Hassen, R. Messaoud, A. Ladjimi, M. Khairallah Abstract : Purpose: To describe an unusual case of a large tractional macular break. Methods: Case report. Results: A 38-year-old healthy man presented with a sudden decrease of vision in his left...

SYMPOSIUM: VITREOMACULAR INTERFACE VISUALIZATION / SURGICAL APPROACH Moderators: Claudio Azzolini, Etienne Bovey Tuesday, June 21, 2005 Pars plana vitrectomy (PPV) with ILM peeling in maculer hole surgery Author: Yaprak Banu Ünver, MD, Nur Acar, MD, Ziya Kapran, MD, Mehmet Cakır, MD, Zerrin Bayraktar, MD, Tugrul Altan, MD, Eylem Y. Pınarcı, MD Abstract : In stage 2, 3 and 4 maculer holes, anatomical and functional success is...

http://www.evrs.eu/medias/2010/congress/Branch-Retinal-Vein-Occlusion-Central-Retinal-Vein-Occlusion.flv Zofia Michalewska, Jerzy Nawrocki (Lodz, Poland) Advantages: Spectral OCT (SD-OCT) allows visualizing differences between idiopathic non- full thickness macula defect, as lamellar macular hole or macular pseudo hole and non- full thickness macula defect secondary to vascular diseases, as vein occlusion, diabetic macular edema and...

Authors: Elmas Kubilhan, Bilen Özgür, Arsen Akýncý, Ersel Özkýlýç, Ali Altýnsoy, Ankara, Turkey Purpose: To study effect of inserting part of the internal limiting membrane to macular hole to form a bridge. Methods: In a prospective study the records of a consecutive series of 5 patients with full-thickness idiopathic macular holes operated with ICG-assisted ILM peeling by a single surgeon were analyzed. All patients underwent a...

http://www.evrs.eu/medias/2009/congress/Controversial-Techniques.flv Authors: George Pappas, Theoni Panagiotoglou, Dimitris Raptakis, Vasiliki Kounali, Paraskevi Drakou, Nikos Nikoletakis, Heraklion, Greece Advantages: To report the surgical outcome and the safety profile of massage around large macular holes in order to achieve closure. Methods: We have reviewed the notes of 12 patients who underwent pars plana vitrectomy (PPV) for large...

http://www.evrs.eu/medias/2009/congress/Controversial-Techniques.flv Authors: Ural R. Altynbayev, M.M. Bikbov, Ufa, Russia Advantages: The method allows achieving an intraoperative approximation of the edges in stage 3 – 4 macular holes, to prevent mechanical damage of photoreceptors and pigment epithelium and to improve anatomical and functional outcomes. Methods: The present study includes 12 patients with idiopathic macular hole...

http://www.evrs.eu/medias/2009/videos/JerzyNawrocki_2_VP6_768K.flv Authors: Jerzy Nawrocki, Zofia Nawrocka, Janusz Michalewski, Zofia Michalewska, Lodz, Poland Advantages: To present the formation of macular hole and mechanism of its closure after vitrectomy. Methods: Both eyes of patients with macular holes were examined with spectral OCT (6 and 3um resolution). Effectiveness / Safety: Three different types of macular hole formation were...

http://www.evrs.eu/medias/2009/videos/JerzyNawrocki_1_VP6_768K.flv Authors: Jerzy Nawrocki, Zofia Michalewska, Zofia Nawrocka, Janusz Michalewski, Lodz, Poland Advantages: To present a new idea of macular hole closure with the use of inverted ILM flap as a base membrane to improve the results in large, long-lasting macular hole. To evaluate postoperative results after vitrectomy in lamellar macular hole. Additionally to determine factors...

Jerzy Nawrocki, Zofia Michalewska, Zofia Nawrocka, Janusz Michalewski, Lodz, Poland Advantages: To present a new idea of macular hole closure with the use of inverted ILM flap as a base membrane to improve the results in large, long-lasting macular hole. To evaluate postoperative results after vitrectomy in lamellar macular hole. Additionally to determine factors influencing postoperative outcome after vitrectomy for lamellar macular...

Eylem Yaman Pinarci Advantages: Methods: Effectiveness / Safety:

http://www.evrs.eu/medias/2008/congress/Macular-Hole:-An-Easier,-Faster-and-More-Efficient-Gas-Injection-Technique.flv Didier Ducournau Advantages: A 40-seconds technique allowing injection of 3 to 3.2cc of 50% SF6 avoiding strict prone positioning of the patients head. Methods: The minimum bubble volume necessary to occlude a macular hole when the patient is looking in front of him is estimated to be around 2.6cc. After closing the...

http://www.evrs.eu/medias/2008/congress/Staining-of-Internal-Lmiting-Membrane-with-Brillant-Blue-G-Under- Air-for-Macular-Hole-Surgery.flv W. Ho, J Ellis Advantages: We were used to injecting trypan blue under air for the same purpose. We think that this technique is more efficient in ensuring optimal and adequate contact between the dye and ILM. We found that ILM takes up stain more effectively with brilliant blue G compared to trypan...

http://www.evrs.eu/medias/2008/congress/ILM-as-an-Adjuvant-for-Stage-IV-Macular-Hole-Surgery.flv Jerzy Nawrocki, Zofia Michalewska, Zofia Nawrocka, Janusz Michalewski Advantages: The aim of this presentation is to demonstrate a new technique in macular hole surgery in cases of large stage IV macular holes. Leaving a 1-2mm remnant of ILM on the surface of the macular hole improves visual and anatomic outcomes in patients with stage IV...

http://www.evrs.eu/medias/2008/congress/Use-of-Delicate-Maculorhexis-During-Macular-Hole-Surgery.flv Shkvorchenko D.O., Sharafetdinov I.H.*, Kachalina G.F., Pedanova E.K., Belikova S.V. Advantages: We elaborated the modification of maculorhexis to decrease surgical trauma. It consists of the removal of ILM around the macular hole, except the sector of preferred retinal locus (PRL). Preoperative microperimetry (fundus-related perimetry)...

http://www.evrs.eu/medias/2008/congress/Outcome-of-Vitrectomy-for-Lamellar-Macular-Hole.flv Hassan Mortada Advantages: The diagnosis, pathogenesis and the best therapeutic approach for lamellar macular hole is still unclear. This work describes the surgical technique used for management of these cases and the postoperative anatomical and functional results. Methods: Sixteen eyes with symptomatic lamellar macular hole underwent 20-gauge (6...

Miguel Angel Quiroz-Reyes, MD (Mexico City, Mexico), Carmen Lizana, MD (Mexico, City, Mexico) PURPOSE: Is the limitorrhrexis an efective and secure technique to improve the anatomic and functional outcomes in idiopathic macular hole patients? METHODS: Retrospective study of patients with stage 2 to 4 idiopathic macular hole who underwent vitrectomy with and without dye-assited limitorhexis between the year 2000 to 2005. RESULTS: Fifty nine...

Willemine De Vries Knoppert, MD (Amsterdam, The Netherlands), Peter Ringens, MD, PhD, PURPOSE: To report a case of a macular hole as a result of Terson’s syndrome and to postulate a new hypothesis regarding the mechanism of macular hole development. METHODS: A case report with clinical and surgical findings. RESULTS: A 57-year-old woman developed a subarachnoid haemorrhage with a subinternal limiting membrane (ILM) haemorrhage in the...

http://www.evrs.eu/medias/2006/congress/Idiopathic-Macular-Holes-Following-Pars-Plana-Vitrectomy-for-Retinal-Detachment.swf http://www.evrs.eu/medias/2006/congress/Idiopathic-Macular-Holes-Following-Pars-Plana-Vitrectomy-for-Retinal-Detachment-1.flv http://www.evrs.eu/medias/2006/congress/Idiopathic-Macular-Holes-Following-Pars-Plana-Vitrectomy-for-Retinal-Detachment-2.flv Francesco Boscia, MD (Bari, Italy), Homayoun Tabandeh, MD...

http://www.evrs.eu/medias/2006/congress/Results-of-Surgical-Management-of-Senile-Macular-Holes-by-25-gauge-Trans-conjunctival-Sutureless-Vitrectomy-Compared-to-Standard-Vitrectomy-Systems.swf http://www.evrs.eu/medias/2006/congress/Results-of-Surgical-Management-of-Senile-Macular-Holes-by-25-gauge-Trans-conjunctival-Sutureless-Vitrectomy-Compared-to-Standard-Vitrectomy-Systems.flv C. Christopher Brown, MD (Cleveland, OH), David G. Miller,...

Steve T. Charles, MD (Memphis, TN)* SYNOPSIS An initial procedure using 25G PPV, ILM peeling and C3F8 gas failed. A 25G second procedure is the subject of the video. An arcuate retinotomy was made temporal to the macula using 25G Revolution DSP scissors.

Federica Genovesi-Ebert, MD (Pisa, Italy), Stanislao Rizzo, MD (Pisa, Italy), Andrea Vento, MD (Pisa, Italy), Sofia Miniaci, MD (Pisa, Italy), Michele Palla, MD (Pisa, Italy), Claudia Belting, MD (Pisa, Italy) PURPOSE: 25-g sclerotomies may not be airtight if extensive vitrectomy with air-fluid exchanges is required. We treated MH with 25-g TSV using a modified trocars insertions to achieve airtight sclerotomies, and autologous whole blood...

Bohdana Kalvodova, MD (Prague, Czech Republic), Jaroslava Duskova, MD, PhD (Prague, Czech Republic), Tarek Aboutable, MD, PhD (Prague, Czech Republic), Martin Janek, MD (Prague, Czech Republic), Evantia Omoscharkas, MD (Prague, Czech Republic) PURPOSE: Removal of the posterior hyaloid and ILM during microsurgery appears to have a positive influence on the resolution of diabetic macular edema (DME) and idiopathic macular hole (IMH)....

http://www.evrs.eu/medias/2006/congress/ILM-Peeling-Prevents-Late-Reopening-of-Closed-Macular-Holes.swf http://www.evrs.eu/medias/2006/congress/ILM-Peeling-Prevents-Late-Reopening-of-Closed-Macular-Holes.flv Thierry C. Verstraeten, MD (Pittsburgh, PA) PURPOSE: Does the persistence of ILM on the retinal surface after vitrectomy with successful closure of macular holes lead to recurrent tangential traction and reopening of holes either...

http://www.evrs.eu/medias/2006/videos/25-Gauge-Transconjunctival-Sutureless-Vitrectomy-(TSV)-for-the-Treatment-of-Myopic-Macular-Holes-(MH)-Complicated-by-Retinal-Detachment-(RD).flv Stanislao Rizzo, MD (Pisa, Italy), Federica Genovesi-Ebert, MD (Pisa, Italy), Michele Palla, MD (Pisa, Italy) SYNOPSIS 25-g TSV allows a faster patient’s recovery but sclerotomies can leak. We treat a myopic MH with RD where extensive vitrectomy with gas...

http://www.evrs.eu/medias/2006/congress/Prospective-Randomized-Clinical-Trial-Comparing-Face-Down-Position-and-Semi-seated-Position-after-Surgery-for-Idiopathic-Fullthickness-Macular-Hole.swf Alexandre Guillaubey, (Dijon, France), Pierre-Olivier Lafontaine, MD (Dijon, France), Laure Malvitte, MD (Dijon, France), Jean-Paul Berrod, MD (Nancy, France), Catherine Creuzot, MD (Dijon, France) PURPOSE: To determine the influence of face down...

http://www.evrs.eu/medias/2006/congress/Combined-Phacoemulsification-and-Vitrectomy-for-Macular-Hole-Repair.swf Ioannis P Theocharis, MD (Athens, Greece), Zoran Tomic (Uppsala, Sweden), Nasser Jadidi Gili, MD (Uppsala, Sweden) PURPOSE: To assess the outcome of simultaneous phacoemulsification, pars plana vitrectomy and intraocular lens implantation in eyes with macular hole. METHODS: A retrospective non-comparative consecutive series of 64...

J. Fernando Arevalo, MD, FACS (Caracas, Venezuela), Reinaldo A. Garcia, MD (Caracas, Venezuela) SYNOPSIS We report a case of macular hole surgery complicated by accidental massive subretinal indocyanine green (ICG), and retinal tear through the papillomacular bundle. Our anatomic and functional results were poor with retinal and RPE atrophy, and a VA of 20/150. Unnecessary persistent subretinal ICG should be avoided, and precautions should...

http://www.evrs.eu/medias/2006/videos/Condiments-in-Vitreoretinal-Surgery:-A-Bad-Day-in-the-Kitchen.flv J. Fernando Arevalo, MD, FACS (Caracas, Venezuela), Reinaldo A. Garcia, MD (Caracas, Venezuela) SYNOPSIS We report a case of macular hole surgery complicated by accidental massive subretinal indocyanine green (ICG), and retinal tear through the papillomacular bundle. Our anatomic and functional results were poor with retinal and RPE...

Slawomir Cisiecki, (Sieradz, Poland), Janusz Michalewski, MD (Lodz, Poland), Zofia Michalewska, MD (Lodz, Poland), Jerzy Nawrocki, MD (Lodz, Poland) PURPOSE: To evaluate the correlation between S-OCT and visual acuity after macular hole surgery after macular hole surgery. METHODS: This study involved eyes who had undergone anatomically succesful idiopathic macular hole surgery. Association between type of macular closure, size of well...

Mahmoud Soliman, (Cairo, Egypt) PURPOSE: To describe the development and behaviour of full thickness macular holes in patients with Best Vitelliform Macular Dystrophy (BVMD) and Behcets disease. METHODS: The study includes six male and one female patients with an average age of 35 (range; 30-40). Three cases of Best Vitelliform Macular Dystrophy, clinically and electrophysiologically confirmed diagnosis, and four cases of Behcets disease...

http://www.evrs.eu/medias/2005/congress/Results-of-Surgery-in-Traumatic-Macular-Holes.swf Tugrul Altan, Mehmet Çakir, Ziya Kapran, Irfan Perente, Nur Acar, Yaprak B. Ünver, Zerrin Bayraktar, Canan Aslı Utine Purpose: To evaluate the anatomical and functional success of pars plana vitrectomy (PPV) in traumatic macular holes. Methods: The records of 5 eyes of 5 patients who underwent PPV due to traumatic macular hole between September 2001...

http://www.evrs.eu/medias/2005/congress/Does-Using-Intravitreal-Triamcinolone-Acetonide-During-ILM-Peeling-Affect-the-Outcome-of-Macular-Hole-Surgery.swf Murat Karacorlu, Hakan Ozdemir, Serra Arf Karacorlu Purpose: To evaluate functional and anatomical outcome of triamcinolone acetonide assisted internal limiting membrane (ILM) peeling in patients with macular hole. Methods: Fifteen eye of 15 consecutive patients were identified with stage...

http://www.evrs.eu/medias/2005/congress/Is-Face-Down-Positioning-Necessary-in-Macular-Hole-Surgery.swf Jan-Olof Carlsson Purpose: To evaluate the possibility of abandon face down positioning in order to widen the indications for idiopathic macular hole surgery and to facilitate the postoperative period without compromising the success rate. Methods: One experienced surgeon, using a standard 3-port vitrectomy, ILM peeling and fluid-gas...

Didier Ducournau The standard complete gas exchange technique using 20% SF6 is time consuming and a little bit complicated. Considering our needs and the physico-chemical laws of gas expansion and resorbtion, the author proposes a faster, easier and perhaps more effective technique.

Khaled El-Rakhawy, MD Background: Myopic macular holes are different from idiopathic macular holes in their epidemiological characteristics, clinical presentation, surgical objectives and outcome. Some of the still ongoing controversies in the management of both conditions include the role of ILM removal as well as the technique used to achieve this, whether with or without staining. Methods: In vitrectomy for idiopathic macular holes,...

Kh. P. Takhchidi, O. A. Ulasevich Purpose: Visual outcome of surgical treatment for IMH stages 3 and 4 is defined by IMH size and damage of underlying retinal layers. The question of surgical treatment reasonability for IMH stages 2 and, especially, stage 1 remains open. Our aim is to analyze the surgical treatment of initial stages of IMH with OCT. Methods: Patients with initial stages of IMH (9 eyes with stage 1 and 16 eyes with stage 2)...

Mario Pacini Purpose: To evaluate visual outcome and progression towards full thickness macular hole (MH) on patients presenting impending macular hole and operated by internal limiting membrane (ILM) peeling technique. Methods: A retrospective study of 54 eyes of 52 patients presenting impending macular hole (stage 1). All pre- and post-op visual acuities were informed by referring doctors. A 2-port vitrectomy under slit lamp illuminating...

http://www.evrs.eu/medias/2005/congress/An-unusual-large-tractional-macular-break.swf S. Ben Yahia, S. Jenzeri, B. Jelliti, S. Aouafi, M. Oueld El Hassen, R. Messaoud, A. Ladjimi, M. Khairallah Purpose: To describe an unusual case of a large tractional macular break. Methods: Case report. Results: A 38-year-old healthy man presented with a sudden decrease of vision in his left eye. He had no history of ocular trauma. Visual acuity was 20/20...

Jan-Olof Carlsson Purpose: The advantage of bimanual vitrectomy is wellknown by vitreoretinal surgeons. The reason for using a prototype of an illuminated vitrector is an ambition to further facilitate development of this technique. The primary purpose of the study was to evaluate the capacity and consistency of this instrument as the only vitrectorprobe used, both in straightforward and complex surgery. The other purpose was to evaluate...

http://www.evrs.eu/medias/2005/congress/Kenalog-Assisted-Removal-of-ILM-in-Macular-Hole-Surgery.swf Theodoros Potamitis Purpose: To assess the value of kenalog coating in the removal of ILM for macular hole surgery. Methods: The results of 44 cases of macular holes, stages III and IV, treated surgically are reviewed. The results of cases performed without kenalog (18) are compared to those in which kenalog was used to aid the removal of the...

H. Hoerauf, J. Beutel, G. Dahmen, A. Ziegler, H. Laqua Purpose: To investigate the influence of indocyanine green (ICG) or Trypanblue (TB) for ILM removal on visual and anatomical outcome in macular hole surgery. Patients and Methods: 40 patients with idiopathic macular holes stages II-IV underwent pars plana vitrectomy with ILM-delamination. The patients were randomly devided into group I (20 patients) using 0.2 ml of ICG solution (0.05%...

Nawrocki Jerzy, Nawrocka Zofia, Michalewska Zofia, Michalewski Janusz Purpose: The aim of the video is to present the technique of macular hole and macular pucker surgery with the use of trypan blue. Methods: Standard pars plana vitrectomy is performed. After closing the infusion line trypan blue staining is injected slowly on the macula surface. After one minute trypan blue staining is removed. Removal of epiretinal membranes and the ILM...

http://www.evrs.eu/medias/2005/congress/Pars-Plana-Vitrectomy-(PPV)-with-ILM-Peeling-in-Maculer-Hole-Surgery.flv Yaprak Banu Ünver, MD, Nur Acar, MD, Ziya Kapran, MD, Mehmet Cakır, MD, Zerrin Bayraktar, MD, Tugrul Altan, MD, Eylem Y. Pınarcı, MD In stage 2, 3 and 4 maculer holes, anatomical and functional success is achieved with vitreoretinal surgery (VRC). Internal limiting membran (ILM) peeling with or without staining increases the...