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Three Monthly Ranibizumab for ME Secondary to BRVO: 12-month Outcomes

Purpose: To assess 12-month efficacy of the three monthly intravitreal injections of ranibizumab for the treatment of macular oedema (MO) secondary to branch retinal vein occlusion (BRVO) in comparison with combined treatment (a single intravitreal injection of ranibizumab followed by grid laser treatment). Methods: Subjects were 19 patients (19 eyes) with unilateral vision loss attributable to macular oedema following BRVO. Duration of the...

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Flow Control Vitrectomy : Ratio Risk-benefit with Current Pumps

The individualized evaluation of the ratio benefit-risk is defined by the maximal gel amount that can be effectively aspirated in the minimal amount of time (the “benefit”), without iatrogenic browsing of the retina or the ciliary epithelium (the “risk”). For a given vitrectomy machine, the aspiration flow of the vitreous (a viscoplastic medium not susceptible to distortion) varies inversely with its viscosity (Poiseuille law of...

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Stellaris PC: A Ventury Pump for Fellows in Training

The Stellaris PC is a ventury pump vitrectomy machine. As you know, the control of the vacuum is the main parameter of the setting available in the software. The new interface gives you the opportunity to optimize and increase the security during the procedures. Purpose: The communication aims to explain how to use the different combinations to give the best sensations to the surgeon, well adapted to the way he manages the...

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Let’s Try to Understand

The EVRS RD study, analyzed by the French National Institute of Statistics, demonstrated that vitrectomy performed with a Venturi pump machine almost triples the failure rate compared to the use a flow-control pump, independently of the surgeon’s experience, age and nationality. Let’s try to explain why. Since a Venturi pump does not allow to control the quantity of liquid entering the hand piece, a low cutting speed cannot be used...

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Flow Controlled Vitrectomy and EVA – The Clinical Experience

Purpose: Much lively discussion continues regarding the effectiveness of conventional vitrectomy using a vacuum based system as compared to a flow based system. In the last year, a combination system with both vacuum and flow capabability, (EVA® DORC) was released for use in the United States. This new technology has allowed for a comparison of the two platforms using the same unit. In addition, this unit also has anterior segment...

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The Smaller, The Safer

Advantages: The use of 25ga+ and 27ga+ surgery with Constellation enables a more delicate and precise surgical manipulation on the retina surface, making vitrectomy safer. Methods: 1. The duty cycle (Core or Shave) and the fast cutting rate (5000 cpm)  are advantageous namely for beginners, however, it is mainly the smaller flow, thanks to the smaller gauge, which makes the surgery safer. 2. Both the vacuum and the flow can be precisely...

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23 G, 25 G, 27 G … What to Choose ?

At the beginning of 25G “era”, several disadvantages were observed, and it was initially considered as a non adapted technology for difficult cases and essentially used for macular surgery. The 23G vitrectomy was the learning standard witch optimized the access to the 25G surgery However, with the optimisation of the new vitrectomy machines, the 25G has become the reference standard in vitreoretinal surgery. The combination of new...

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In Vivo IOP Monitoring During Microincision PPV With or Without an Active Intraocular Pressure Control System

We have studied in vivo IOP fluctuation during the vitrectomy with or without an active intraocular pressure control system. Both systems are still imperfect during the high intraocular pressure procedures. However, during hypotony procedures, constelletion was quite stable. In addition, using cuttling on mode, non-valved cannular and/or vent system, the IOP can be somewhat controlled. Objective: To compare the in vivo intraocular...

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27 G Microincision Vitrectomy Surgery

Introduction: In the last years vitreoretinal surgery underwent major technical advances, especially with the most recent high frequency vitrectors and microincision systems with progressively smaller caliber, such as the 27-gauge vitrectomy system. This video aims to illustrate our pars plana vitrectomy experience with this small-gauge vitrectomy system. Material and Methods: Retrospectively we selected and analyzed all patients that...

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Vitrectomy Under Air in Rhegmatogenous RD Surgery

After perfoming central vitrectomy, I inject perfluro-carbon liquid (PFCL) into the vitreous cavity, to re-attach retina, up to the level of the retinal breaks. If there are no detectable breaks, I inject the PFCL as peripheral as possible up to the level of the posterior border of the vitreous base. Subsequently, air is infused, to fill the anterior part of the vitreous cavity. At the air level: I perform meticulous shaving of the...

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Rhegmatogenous Retinal Detachment: Basic Concepts and Surgical Strategy for Primary Vitrectomy

Contrary to popular dogma, the most important element in the pathogenesis of a rhegmatogenous retinal detachment (RRD) is not the break but the vitreoretinal traction that causes the break (i.e., the RRD is a vitreogenic pathology). In the presence of vitreous degeneration (syneresis) such dynamic traction is inevitable if the eyeball and/or the head moves: this hypothesis is supported by the clinical observation that a RRD spontaneously...

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Select Your Vitrectomy Machine Parameters with EVA

The EVRS RD study, analyzed by the French National Institute of Statistics, demonstrated that vitrectomy performed with a Venturi pump machine almost triples the failure rate compared to the use a flow-control pump, independently of the surgeon’s experience, age and nationality. Let’s try to explain why. Contact Details: Email: ddd@club-internet.fr Cell Phone:...

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Choosing Between a Venturi and a Peristaltic Vitrectomy Machine is Like Choosing a Rear- or a Front-wheel Drive Car

Fluidistic in phacophagy have long been a question for anterior-segment surgeons to obtain the more stable machine to operate. Nowadays, cataract surgery is becoming a standardised surgery with excellent statistical results due, among others, to an excellent stability of the anterior chamber depth and an excellent control of the machines. However, choosing the right machine continues to be questionable during vitrectomies, partially because...

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Small Gauge Surgery is a Real Progress

Advantages: My long time delayed conversion from 20 Gauge to 25 Gauge + surgery in 2012 showed even more benefits than Alcon declared. My trust in a better accuracy of 20 Gauge surgery proved to be wrong and I have operated over 1400 patients with a higher success rate than before. Well known are the “cosmetic” advantages of small gauge surgery (shorter procedure, patients´ comfort, less inflammation, no astigmatism),...

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Why Did I Choose the Constellation?

The Constellation Vision System by Alcon is a well known vitrectomy machine. The vitreous cutter is a new “swiss knife” in vitreo-retinal surgery with two great advantages: on one hand related with its design, with an optimized port location placed closer to the tip, allowing cutting, dissection, aspiration, etc. On the other hand, the active opening-closing sequence, which controls and improves the duty cycle during the...

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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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Rhegmatogenous Retinal Detachment: Basic Concepts and Surgical Strategy for Primary Vitrectomy

Contrary to popular dogma, the most important element in the pathogenesis of a rhegmatogenous retinal detachment (RRD) is not the break but the vitreoretinal traction that causes the break (i.e., the RRD is a vitreogenic pathology). In the presence of vitreous degeneration (syneresis) such dynamic traction is inevitable if the eyeball and/or the head moves: this hypothesis is supported by the clinical observation that a RRD spontaneously...

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Entry Site Hemorrhage: An Uninvited Outsider

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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Blood in Anterior Chamber at the End of Surgery

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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Trocar Loss

Contact Details: Email: jp.berrod@gmail.com Cell Phone:...

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RD During 23G MER Surgery

Contact Details: Email: jp.berrod@gmail.com Cell Phone:...

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Air in AC Due to Uncomplete PH Detachment

Contact Details: Email: jp.berrod@gmail.com Cell Phone:...

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Complications During 23G Trocar Insertion

Contact Details: Email: ihabsaad@hotmail.com Cell Phone: /+201001768768

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Suprachoroidal Infusion Line

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:...

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Chair Movement

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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23G Complications Collection

Contact Details: Email: jflerouic@gmail.com Cell Phone: /+33660166157

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Postoperative Changes in Astigmatism After Small Gauge TSV Versus 20 Gauge Conventional Vitrectomy

Pei-Kang Liu_SCIENTIFIC POSTER 2015 Purpose: Surgically induced astigmatism is an unwanted variable that can lead to poorer visual and refractive outcomes in patients undergoing vitrectomy. The study evaluates the changes in regular corneal astigmatism after transconjunctival sutureless vitrectomy (25-gauge or 23-gauge) and 20-gauge conventional vitrec tomy. Methods: The study is a retrospective comparative case series of vitrectomies...

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Entry Site Hemorrhage: An Uninvited Outsider

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...

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Triple Procedure

Severe ocular trauma is often a chalenge for a retinal surgeon as in this case. A 74 years old patient is referred for the treatment of severe contusion occurred during a car accident three weeks before. The visual acuity is reduced to light perception and examination shows: large iridodyalysis exceeding 200 degrees, posterior lens dislocation, vitreous hemorrhage, no retinal detachment on B scan A Triple procedure is decided and...

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Bi-linear Aspiration Flow & Cutting Frequency Control and Segmentation in PDR

Media not available due to technical recording problems. EVRS is very sorry for the inconvenience.   Different techniques have been described for the dissection of proliferative diabetic retinopathy (PDR). When there is a strong adherence between the fibrovascular proliferation and the retinal vessels, segmentation is a safe technique to reduce the risk of bleeding and retinal tear. With the advance of vitrectomy machines, the control...

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Sclerotomy Construction in Pediatric Vitrectomy

Media not available due to technical recording problems. EVRS is very sorry for the inconvenience.   Pediatric vitreoretinal surgery is completely different from adult surgery because of the anatomical considerations. These differences start with the sclerotomy construction since the pars plana is not well developed. Here I will talk about the tricks of the sclerotomy construction in vitrectomy for ROP and PFV syndromes specifically to...

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The Occam´s Razor for RD Surgery

Media not available due to technical recording problems. EVRS is very sorry for the inconvenience.   Advantages: Heavy perfluorocarbon liquids (PFCL) were first used regularly by Chang since 1987 and represents in complex rhegmatogenous retinal detachment (RRD) surgery a unique tool. Because of it´s tamponade pressure, 12 to 14 times more than silicon oil (SO), this liquid is able to express subretinal fluid posteriorly in many...

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New Applications for Microincision Vitrectomy Trocars

Vitreo-retinal surgery had incredible advancements over the last decades. Development of new vitrectomy machines, endoillumination and viewing systems and obviously the microincision vitrectomy surgery (MIVS), made this kind of procedures faster and safer. Essential for MIVS, trocars were developed allowing an easy and atraumatic transconjuntival entry to the posterior segment. In the recent years several improvements in this type of...

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Vitrectomy in Diabetic Macular Edema

For many years, pars plana vitrectomy with posterior hyaloid detachment and peeling of internal limiting membrane (ILM) has been considered a treatment option for diabetic macular edema by retina surgeons worldwide. The 2012 large scale study by EVRS surgeons showed that the surgical option alone resulted, by far, in the most significant visual acuity improvement. However the surgical treatment has, so far, failed to gain widespread...

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Intraocular Video Analysis of Small Gauge Vitrectomy in Human Cadaver Eyes Using a Modified Zirm Technique

Purpose: To assess the intraocular effects of small gauge vitreous surgery particularly in the area of the vitreous base, using High Definition (HD) intraocular cameras and slow motion analysis, studied in freshly enucleated human eyes. Methods: 20 freshly enucleated human eyes underwent vitrectomy using a modified Zirm imaging technique using HD and high speed cameras. 23, 25, and 27 gauge instruments were compared at a variety of cut...

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High Infusion Flow in Mini Invasive Vitrectomy

Media not available due to technical recording problems. EVRS is very sorry for the inconvenience.   In flow rate vitrectomy, the major concept is »isoflow » which means that you need to perform a vitrectomy with an equal flow for the infusion and for the aspiration. This is the mandatory condition to allow a vitrectomy in « isopressure”. This understanding leads you to an important concept which is that your infusion flow...

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My Machine Parameters for Central and Peripheral Vitrectomy

Media not available due to technical recording problems. EVRS is very sorry for the inconvenience.   During a central vitrectomy I want to remove the central vitreous without hypotonia, to avoid incarceration and to induce retinal tears at the vitreous base level, and I want to do it efficiently. I can easily avoid any hypotonia in choosing my maximum aspiration flow always lower than my maximum infusion flow; so the first thing to do...

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The Lower Temporal Trocar: Alternative Use

Media not available due to technical recording problems. EVRS is very sorry for the inconvenience.   Normally the lower temporal trocar is for the infusion cannula. I use it for: • Laser probe: to do laser for peripheral upper retina 10 and 2‘clock position • Cutter for shaving of the vitreous base in the upper retina between 10 and 2‘clock • Cutter, Forceps, scissors and pick for membranes dissection for membranes in the...

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Comparison of Anterior Segment Complications Between PPV vs PPV Combined with Cataract Surgery

Poster Berna Ozkan Purpose: To compare the postoperative anterior segment complications in patients who had pars plana vitrectomy versus pars plana vitrectomy combined with cataract surgery. Methods: Medical records of 84 patients of who underwent pars plana vitrectomy with previous had cataract surgery (sequential group) and 88 patient who underwent pars plana vitrectomy combined with cataract surgery (combined group) were reviewed...

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Comparison of Clinical Outcomes of 25 and 23 Gauge Vitrectomy for PDR

Poster Mehmet Onen Purpose: To compare anatomical and functional outcomes of 25 gauge and 23 gauge transconjunctival sutureless vitrectomy (TSV) for treatment of proliferative diabetic retinopathy (PDR). Methods: Retrospective review of 81 consecutive eyes from 81 patients undergoing 25 gauge and 23 gauge TSV with a minimum of 6-month follow-up (vitreous hemorrhage (VH), n=51; tractional retinal detachment (TRD), n=30). Vitrectomy was...

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Primary Repair of Rhegmatogenous RD Using 25 Gauge Transconjuctival Sutureless Vitrectomy

Poster Younghoon Lee Purpose: To evaluate 25-gauge transconjunctival sutureless vitrectomy for primary repair of rhegmatogenous retinal detachment. Methods: A retrospective, non-comparative interventional case series including 37 consecutive eyes of 37 patients who underwent 25-gauge transconjunctival sutureless vitrectomy to repair primary rhegmatogenous retinal detachment was performed. Variables collected for the study were patient...

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23 Gauge Pars Plana Vitrectomy in Patients with Rhegmatogenous Retinal Detachment and Choroidal Detachment

Purpose: To share the problems of 23g PPV for patients with retinal detachment and choroidal detachment. Material & Methods: Seven patients with retina and choroidal detachment were included in this study. Preoperative and other routine eye examination [BCVA, biomicroscopy, intraocular pressure, fundoscopy, A-B scan ultrasonography if needed] were recorded. The surgical findings and complications were recorded [infusion cannula...

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The Appropriate Timing of Pars Plana Vitrectomy After Pretreatment with Intravitreal Bevacizumab for Proliferative Diabetic Retinopathy

Purpose: The purpose of this study was to determine the appropriate timing of pars plana vitrectomy after pretreatment with intravitreal bevacizumab (IVB) for proliferative diabetic retinopathy using histopathological examination of epiretinal membrane biopsies. Material & Methods: This prospective study was conducted in Maghrabi Eye Hospital & Kuwait University Hospital, Sana, between January 2009 – May 2010. Forty...

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Pars Plana Lensectomy / Vitrectomy in Stages 4 and 5 ROP

Stage 5 ROP is a severe form of ROP resulting in retinal detachment and visual blindness. Pars plana lensectomy vitrectomy may offer a dismal prognosis in fixing these detachments.

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Salvage of a Suprachoroidal Infusion

Purpose: To define different approaches in case of suprachoroidal infusion cannula. Methods: Two different ways will be demonstrated to solve this problem. Effectiveness: Both of the solutions work quite safely. Take home message: This problem may occur during the learning curve especially in hypotonic eyes. Extra care should be taken to avoid this problem in such eyes. When it occurs, one of these ways can be chosen to solve the...

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30 Gauge Pars Plana Surgery in Recurrent Vitreous Hemorrhage: The Micro-invasive Technique

Advantage: Recurrent vitreous hemorrhage is common after vitrectomy which needs repeat surgery. Repeat intervention using standard technique is associated with considerable inflammatory response and delayed visual recovery that calls for a less invasive technique. The micro-invasive 30 gauge surgery for recurrent vitreous hemorrhage is safe, and effective. Methods: In this pilot study seven eyes of six patients underwent two-port 30...

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27 Gauge One Pars Plana Port Vitrectomy with a Reflow Strategy for Macular Diseases and Beyond

Advantages: To report our results for macular hole using anterior chamber infusion during the reverse zonular flow “Reverse flow“ (personal technique) one port pars plana 27 gauge vitrectomy technique. Methods: A retrospective analysis of 10 eyes which underwent re-flow one port 27 gauge vitrectomy with the infusion in the anterior chamber for macular hole. This technique was used to decrease the turbulence of fluids in the vitreous...

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23 Gauge Probe Surgery in Severe Proliferative Diabetic Retinopathy

Technological advances in 23 gauge probe design and vitrectomy machines, allowed the use of the probe to perform many intraoperative techniques and manipulations during complex diabetic vitrectomy. The aim of this work is to describe techniques for using the 23 gauge vitrectomy probe to manage complex diabetic vitrectomy. 120 eyes with severe complications of proliferative diabetic retinopathy were included in this work. They include cases...

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The Machine Which Speaks to the Ear of the Surgeon

Vitrectomy machines equipped with a flow control pump allow not only to decrease by 300% the number of failures in retinal detachment but can also facilitate the surgeon’s work in providing him information on what he is actually doing. The new EVA machine is equipped with a sound system which allows: to inform the surgeon when the infusion is on to inform the surgeon on the positioning of his foot on the foot pedal (telling him what...

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New Trocars

The use of infusion trocars in the mini invasive transscleral 23, 25 or 27 gauge techniques forces us to a double reduction of the infusion flow by introducing an infusion cannula in the transscleral trocar. Our new concept allows the direct fixation of the infusion pipe on the transscleral trocar, avoiding the double reduction. This induces a considerable lowering of the risk created by a too weak infusion...

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New 27 Gauge Microforceps: Efficiency Depends of the Distal Design

The authors present an improvement to the distal design of a 27 gauge microforceps. This leads to better efficiency for macular surgery, even with a very small 27 gauge instrument. It seems to be one of the first steps to create a real possibility of 27 gauge vitreoretinal surgery.

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Fashioned Instruments for 23 Gauge Vitrectomy

We have to perform our surgical techniques with utmost efficacy, widest safety margin, and least cost. Some instruments can be fashioned oneself in a way that achieves all targets of 23 gauge vitrectomy: 1. Intravitreal triamcinolone acetonide cannula 2. Heavy liquid (PFC) cannula 3. 23 gauge needle pick 4. Silicone oil cannula 5. Non-bent 23 gauge needle for ILM flap creation. By being able to fashion some simple instruments one can t...

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The Outcome of 23 Gauge Pars Plana Vitrectomy Without Scleral Buckle for Management of Retinal Detachment

Objective / Purpose: To evaluate the effectiveness of 23 gauge pars plana vitrectomy (PPV) without scleral buckle (SB) for management of rhegmatogenous retinal detachment (RRD) even with lower breaks. Methods: The study included 26 patients with total or subtotal RRD without proliferative vitreoretinopathy (PVR) or with PVR grade A, B or C1. All the patients underwent 23 gauge PPV without SB, shaving of the vitreous base with internal...

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A Piece of Steel Removed by 23 Gauge Vitrectomy

An intraocular foreign body (IOFB) must be excluded in all cases of eye perforation. An IOFB may traumatize the eye mechanically, introduce infection or cause other toxic effects (i.e.: siderosis) on the intraocular structures. Once in the eye, the foreign body may lodge in any of the structures (in the antherior chamber, in the angle, in the lens, in the vitreous or on the retina).Some of them are inert but an intraocular ferrous foreign...

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Curses and Misfortune of 23 Gauge Vitrectomy

Setting: Vitreoretinal department, clinique Sourdille, Nantes, France Purpose: Although transconjunctical sutureless vitrectomy is a major step forward in vitreoretinal surgery when compared to 20 gauge vitrectomy, it has its own set of complications and shortcomings. We present in this film a series of complications we could record during the last five years. Methods: We selected an anthology of complications and shortcomings specific...

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27 Gauge One Pars Plana Port Vitrectomy with a Reflow Strategy for Macular Diseases

Advantages: To report our results for macular hole using anterior chamber infusion during the reverse zonular flow “Re-flow” (personal technique) one port pars plana 27 gauge vitrectomy technique. Methods: A retrospective analysis of 10 eyes which underwent re-flow one port 27 gauge vitrectomy with the infusion in the anterior chamber for macular hole. This technique was used to decrease the turbulence of fluids in the vitreous...

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Intraperative Choroidal Detachment During PPV with 20 Gauge Claes Cannula System

Choroidal detachment is an uncommon but serious complication of pars plana vitrectomy (PPV) with 20 gauge Claes cannula system. The purpose of this study is to document this rare complication.Seventy year old male patient was operated due to dropped IOL. During retrobulbar anesthesia subconjunctival hemorrhage and chemosis occured. Then 23 gauge infusion line was inserted at inferior temporal margine and opened. 20 gauge Claes cannulas were...

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Comparison of the Vitrectomy Machine Parameters in Rhegmatogenous RD

Our purpose is compare the peristaltic pump and the venturi pump during surgery for rhegmatogenous retinal detachment. We use in our cases dual pump vitrectomy machine. We assess the surgical success in 20 gauge and 23 gauge surgery, and high speed and low speed cutting rate in  both pump systems. Our parameters are iatrogenic retinal tears occuring during the surgery and postoperative proliferative vitre oretinopaty maturing ratio. In our...

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27 Gauge Vitrectomy: A New Technology for the Future

Introduction: The newest technology in vitreoretinal surgery is the 27 gauge instrumentation platform.  We performed a number of 27 gauge procedures and have put together a paper relating our experience and findings with this advanced technology. Materials and Methods: The evaluations utilized 27 gauge surgery on a number of different cases, including but not limited to; epiretinal membrane peel, macular holes, retinal detachments, and...

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27 G One Pars Plana Port Vitrectomy with a Reflow Strategy

Purpose : To report our results for macular hole using the anterior chamber infusion (during the reverse zonular flow “Re-flow”-personal technique) one pars plana port 27G vitrectomy technique. Setting/Venue: Department of Ophthalmology, Hospital S. Maria delle Croci, Ravenna, Italy Methods: A retrospective analysis of 5 eyes which underwent re-flow one port 27g vitrectomy with the infusion in the anterior chamber for macular hole....

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Outcomes of PPV for Non-clearing Vitreous Hemorrhage in PDR

Introduction: Diabetic vitreous errateage often clears in a few weeks. If pan retinal laser photocoagulation is not possible, or there is persistent non-clearing vitreous errateage, vitrectomy should be performed. Purpose: To assess the outcomes of one year follow up of patients who underwent pars plana vitrectomy for non- clearing diabetic vitreous haemorrhage. Methods: Retrospective case note study, analysed notes of patients who...

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Clinical Outcomes of Ultrahigh-speed 23 G with Duty Cycle Control System in the Treatment of PDR Complicated by Tractional RD

Clinical Outcomes of Ultrahigh-speed 23 G with Duty Cycle Control System in the Treatment of PDR Complicated by Tractional RD Jung Ho Lee Advantages:          Dealing with vitreous of detached retina with fibrovascular proliferation and traction complicated by proliferative diabetic retinopathy is a challenge. A higher cutter rate may minimize vitreous turbulence by allowing only small bits of vitreous to enter the port,...

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23-gauge Pars Plana Vitrectomy with Massive Circular Uveal Effusion: A Small Cut with Large Impact

Introduction: While peeling an idopathic epiretinal membrane with a standard 23-gauge vitrectomy the Infusion port dislocated inadvertently and caused a massive uveal effusion. Methods: By using an additional 20-gauge sclerotomy, it is possible to continue the vitrectomy, peeling the macular pucker and the inner limiting membrane in order to successfully complete the surgery. In this case, the 20-gauge sclerotomy serves as a drainage...

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23-gauge Pars Plana Vitrectomy Under Topical Anesthesia

We present the case of a 75-years-old male patient with decreased visual acuity from vitreous hemorrhage. Visual acuity was hand movement. We performed 23 G pars plana vitrectomy under topical anesthesia. The patient was very interested in all surgical procedures. We communicated with him during the surgery. The procedure was completed in approximately twenty minutes without any complications. In both the intraoperative and postoperative...

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Painless, Comfortable and Successful – 27 G Sutureles Vitrectomy and Topic Anesthesia in Tractional Retinal Detachment

Painless, Comfortable and Successful – 27 G Sutureles Vitrectomy and Topic Anesthesia in Tractional Retinal Detachment

Jolanta Oficjalska, Joanna Adamiec-Mroczek, Bożena Gołębiowska (Wroclaw, Poland) Tractional retinal detachment is a common cause of blindness in the working-aged population. Therefore it is important to develop new effective surgical procedures, which would enable a quick return to professional work. We present 53-year-old female with decreased visual acuity from tractional retinal detachment. The patient underwent 27-gauge sutureless...

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How to Increase the Vitrectomy Quality Thus Decreasing Post-op PVR Risk

Didier Ducournau (Nantes, France) If the goal of a vitrectomy is to remove the vitreous as much as we can, we must use machines which allow us to remove the anterior hyaloid and the posterior hyaloid. High-speed cutters and shaving techniques have been invented to decrease the iatrogenic retinal tears risk. In fact, low cutting frequency is dangerous if the operator is not controlling the aspiration flow. But, shaving technique leaves much...

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Incidence of Retinal Detachments After Vitrectomy for Macular Surgery, According to the Set Up of Maximum Vacuum

Jean-Paul Berrod, I. Hubert, J. Selton (Nancy, France) Advantages: Low vacuum setting might reduce the rate of retinal tears and/or retinal detachment after macular surgery. Traction on the peripheral retina during vitrectomy increases with the maximum vacuum set up. The aim of our study was to precise the incidence of retinal tears and retinal detachment after macular surgery depending on the maximum vacuum set up during the...

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Advantages of the Aspiration Flow Control During Peripheral PPV

Jean-Paul Amar (Cannes, France) Whatever the technique used during vitrectomy, physical law will determine the quality and the safety of the PPV. In fact, to perform a complete vitrectomy, some principles are mandatory: • We have to control the flow rate of the cutting system. • In order to decrease the gradient of pressure and this way the dangerous movements of the retina, the occlusion during the closure of the vitrectomy probe...

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Novel Technical Developments to Improve Surgical Safety During Phaco-Vitrectomy for Retinal Detachment

Peter Stalmans (Leuven, Belgium) Purpose: During surgery, several complications can occur: posterior lens capsule aspiration, aspiration of retinal tissue into the cutter during vitreous base shaving and pressure alterations leading to hypotony (inducing collaps and even subchoroidal haemmorrhage) or hypertony (compromising the retinal perfusion). Methods: Several soft and hardware features were developed for the Dual Associate device...

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When the Surgeon’s Eye is Inside the Patient’s Eye

Claude Boscher (Paris, France) Flow control is especially crucial during vitrectomy for retinal detachment because of the risk of iatrogenic retinal tears, due to traction at distance or to direct retinal browsing. Balance between risk and efficiency must be continuously monitored. Endoscopy assisted vitrectomy allows high magnification observation of the vitreous/retinal motion and cutter action. Depending on the vitreous condition and...

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Acute Uncomplicated Retinal Detachment in Presbyopic Patients 
– Is Buckling or Vitrectomy the Better Approach These Days?

Stefanie Pape (Bremen, Germany) With advances in vitrectomy techniques in recent years there has been a trend away from buckling and towards primary vitreous surgery with combined lens exchange for primary uncomplicated retinal detachments in presbyopic patients in which the preservation of the natural lens is of secondary importance. A number of reasons seem to be responsible for this development: • learning vitrectomy techniques seems...

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20 Gauge PPV is Preferred in Patients with Proliferative Diabetic Retinopathy

Maha Elshafei (Doha, Qatar) Cases with advanced proliferative diabetic retinopathy with tough membranes that needs pars plana vitrectomy is better performed with 20 G. The instruments (forceps and scissors) we need in these procedures are way better in dealing with tough membranes. 23 G are suitable for diabetic vitreous hemorrhage with simple...

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CCV – Clear Cornea Vitrectomy

Dalibor Cholevik, Jan Nemcansky (Ostrava, Czech Republic) Advantages: Effective surgical 
treatment 
of 
exudative 
retinal
 detachment 
in 
eye 
with 
nanophthalmus
. Methods: When the sclerotomy is fail in exudative retinal detachment in nonothalmic eye, is PPV needed. The eye is very shot and retinal detachment is total. There is not space for standard PPV. We present non-standard vitrectomy via cornea. Effectiveness...

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Management of Adherent Posterior Hyaloid During Vitrectomy in Eyes with Rhegmatogenous RD

Hassan Mortada (Cairo, Egypt) Advantages: Peeling of adherent cortical vitreous during primary vitrectomy in eyes with rhegmatogenous RD is crucial in achieving complete mobilization of the retina, to remove the scaffold for further proliferation and to achieve long-term retinal stability. The posterior hyaloid may be loosely or strongly adherent or may show vitreoschisis. The aim of this work is to present the behavior of adherent...

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The Functional and Anatomical Changes in Patients with Retinal Detachment After TPPV with ILM Peeling

Robert Rejdak, Malgorzata Pietras-Trzpiel, Katarzyna Nowomiejska, Agnieszka Kalinowska, Tomasz Zarnowski, Cesare Forlini, Anselm Junemann (Lublin, Poland) Advantages: The aim of the study was to evaluate visual function of the macula and changes in retinal layers in patients with retinal detachment following TPPV with Brilliant Peel assisted ILM peeling. Methods: The group consisted of 25 patients (12 male and 13 female) with retinal...

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Should we Always Peel ILM in Stages A and B PVR Retinal Detachment?

Slawomir Cisiecki (Lodz, Poland) Advantages: Peeling of the ILM is an extremely effective prophylaxis for postoperative epiretinal membrane formation and is also a well-known part of primary vitrectomy in more advanced stages (beyond Stage B) PVR retinal detachments. However, some surgeons recommend ILM peeling in general as a macular pucker prophylaxis in all stages of PVR in cases of primary vitrectomy even in macula-on retinal...

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Short-term PFCL Endotamponade in Treatment of Inferior Retinal Detachment

Kh.P. Takhchidi, S.S. Tillyakhodzhaev, A.A. Gorin (Moscow, Russia) Abstract: Modern technologies of vitreoretinal surgery ensure the high anatomical and functional results in the treatment of retinal detachment (RD). The key point investigations in this field are concentrated on the searching of liquids, which can provide short-term effective and sufficient endotamponade for achieving high anatomical and functional results. At present,...

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Detachment Repair Without Heavy Liquid

Theodoros Potamitis (Limassol, Cyprus) Advantages: The use of heavy liquid to flatten bullous retinal detachments, although very simple has several major disadvantages. Adding heavy liquid adds two steps to the process of vitrectomy, injection and removal of the PFCL. If heavy liquid enters the sub-retinal space it turns a simple procedure into a complicated one. The pressure exerted by the heavy liquid can give a false appearance of...

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Incomplete Drain of Subretinal Fluid, During Vitrectomy for Retinal Detachment

Stratos Gotzaridis, Elias Georgalas (Athens, Greece) Advantages: To evaluate the efficacy of incompletely draining subretinal fluid at the end of the vitrectomy for treating retinal detachment cases. Methods: Sixty-seven eyes of 67 patients underwent PP vitrectomy for retinal detachment. Forty of them were macula on and 27 macula off detachments. Endolaser or cryo were used for retinopexy. At the end of the vitrectomy the subretinal...

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Anatomical Results After Primary Retinal Detachment Surgery by MIVS: Role of Triamcinolone Acetonide Assistance and Chandelier Illumination System

Vito Primavera, Isabella Turco, N. Delle Noci (Foggia, Italy) Advantages: To compare the anatomical outcome following small gauge vitrectomy for rhegmatogenous retinal detachment (RRD) between triamcinolone acetonide assistance and chandelier illumination system. Methods: Retinal detachment repair was performed by the same surgeon. 120 eyes underwent primary vitrectomy using 23- or 25 plus gauge vitrectomy instruments, a wide-angle...

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Phakic Rhegmatogenous Retinal Detachment: Pars Plana Vitrectomy Combined with Phacoemulsification

Sevil Karaman, Hülya Güngel, Isil Pasaoglu (Osmaniye, Turkey) Advantages: After pars plana vitrectomy cataract development is seen often. Phacoemulsification in vitrectomized eyes is challenging. Combined surgery has advantages preoperatively and postoperatively. Methods: 46 patients underwent pars plana vitrectomy combined with phacoemulsification (by HG) were examined. Functional and anatomic successes were determined. Effectiveness...

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Phaco-vitrectomy Versus Vitrectomy for Primary Rhegmatogenous Retinal Detachment Repair

Woohyok Chang, Byoung Young Gu, Min Sagong (Daegu, South Korea) Purpose: To compare the outcomes of phaco-vitrectomy and vitrectomy for treatment of primary rhegmatogenous retinal detachment. Methods: Retrospective comparison of the anatomical success, functional success and complications between patients in Group I, who underwent vitrectomy only for primary rhegmatogenous retinal detachment, and Group II who underwent phaco-vitrectomy...

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Comparison of 20 and 23-Gauge Pars Plana Vitrectomy Combined with Phacoemulsification in Phakic Rhegmatogenous Retinal Detachment

Sevil Karaman, Hülya Güngel, Isil Pasaoglu, Ozen Osmanbasoglu, Ece Uzun, Dilek Alp (Osmaniye, Turkey) Advantages: To compare prognosis after 20-gauge (G) and 23-G pars plana vitrectomy (PPV) combined with phacoemulsification for repair of primary phakic rhegmatogenous retinal detachment. Methods: 56 phakic patients who underwent primary rhegmatogenous retinal detachment repair with 20-G (n=28) or 23-G (n=28) transconjunctival PPV were...

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Comparison of Postoperative Inflammation and Patient Discomfort Scores Following 20-Gauge, 23-Gauge, and 25-Gauge Pars Plana Vitrectomy in Eyes with Retinal Detachment

Nur Acar*, Yaprak Banu Unver, Leyla Hazar, Nihat Sayýn, Yasar Kucuksumer, Ziya Kapran (Istanbul, Turkey) Advantages: Being less invasive, 23-gauge, and 25-gauge transconjunctival pars plana vitrectomy (PPV) techniques may cause less postoperative inflammation and patient discomfort. In this prospective study the aim was to compare postoperative inflammation and patient discomfort scores in eyes that underwent 20-gauge, 23-gauge, and...

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Primary 25-Gauge, 23-Gauge and 20-Gauge Vitrectomy in Rhegmatogenous Retinal Detachment

Nur Acar*, Ziya Kapran, Yaprak Banu Unver, Yasar Kucuksumer, Turgay Satýcý (Istanbul, Turkey) Advantages: Primary vitrectomy allows visualization of all retinal breaks and performing effective retinopexy while enabling removal of all vitro tractions and membranes. Less invasive PPV techniques like 25-gauge and 23-gauge transconjunctival PPV provide rapid postoperative rehabilitation, and comfort for the patient. Methods: In this...

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Vitrectomy for Rhegmatogenous Retinal Detachment: Why and How

Ferenc Kuhn (Hungary / USA), Zora Ignjatovic (Belgrade, Serbia) Advantages: Even though the retinal break is thought to be the cause of the retinal detachment, the break is secondary to – typically dynamic – vitreoretinal traction. Vitrectomy is the rational approach to treatment by addressing the source, rather than the consequence, as scleral buckling does, however effectively. In addition, other pathologies such as media...

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Pseudophakic Retinal Detachment Surgery by 23 G Vitrectomy, Using Slit-lamp and Non-contact 90D Lens

Etienne H. Bovey, Jean-Antoine Pournaras (Lausanne, Switzerland) Purpose: To describe a new technique of surgery for pseudophakic retinal detachment, using 23G vitrectomy, slit-lamp and non-contact 90D lens. Methods: 42 pseudophakic eyes with retinal detachment were analyzed retrospectively. They were operated on by 23G vitrectomy, transconjunctival cryocoagulation, and internal tamponade with gas (37 cases) or silicone oil (5 cases)....

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Primary Vitrectomy Without Buckle for the Treatment of Retinal Detachment

Jean-Paul Berrod, I. Hubert, R. Ouled-Moussa, M. Casillas (Nancy, France) Advantages: Primary pars plana vitrectomy (P.P.V) is nowadays a common practice to repair retinal detachments in pseudophakic or phakic patients. It reduces periocular and muscle disorders, facilitates visualization of the breaks, and shortens surgical time. The technique was presented at the EVRS meeting in Biarritz in 2001 with excellent initial results of 92%...

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Primary Vitrectomy, Without Buckling, for Rhegmatogenous RD of Intermediate Severity: Technique & Results

Hassan Mortada (Cairo, Egypt) Advantages: The advantages of primary vitrectomy include direct relieve of vitreoretinal traction, removal of inflammatory mediators & cells, intraoperative complete retinal reattachment, choice of the appropriate tamponade and avoiding the complications associated with scleral buckling. This work presents the technique & results of primary vitrectomy without buckling in dealing with RRD of...

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Vitrectomy with Laser Retinopexy and Without Postoperative Gas or Oil Tamponade for Rhegmatogenous Retinal Detachment

Chi Wai Tsang (Hong Kong, China) Advantages: The technique can avoid the complications related to gas or oil tamponade in selected cases of rhegmatogenous retinal detachment. Methods: The operation was performed using wide-angle viewing system (BIOM). The 27G twinlight chandelier system was used to facilitate peripheral vitreous removal under scleral indentation. Perfluorocarbon liquid (PFC) was used to facilitate subretinal fluid...

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23 G Transconjunctival Vitrectomy Techniques in Complicated Retinal Detachment

Hassan Mortada (Cairo, Egypt) Advantages: To evaluate the efficacy of using only 23g transconjuntival sutureless vitrectomy in management of complicated retinal detachment over the past 3 years. The preservation of the integrity of the conjunctiva and sclera in these cases is of crucial importance, as these cases frequently need more than one operation, at least to remove silicone oil. This is a major advantage of 23G over 20G. The...

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Factors Affecting Visual Prognosis After 23 Gauge Vitrectomy Combined with Phacoemulsification in Phakic Retinal Detachment

Isil Pasaoglu, Hülya Güngel, Sevil Karaman, Dilek Alp, Ozen Osmanbasoglu, Ece Uzun (Istanbul, Turkey) Advantages: To analyse the factors affecting visual outcomes of 23-gauge transconjunctival sutureless vitrectomy combined with phacoemulsification in phakic rhegmatogenous retinal detachment. Methods: A retrospective case series study was performed in 56 patients with phakic retinal detachment. Patients with a final visual acuity greater...

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Analysis of the Visual Prognostic Factors of 23 Gauge Vitrectomy in Pseudophakic Retinal Detachment

Hülya Güngel, Isil Pasaoglu, Evre Pekel, Dilek Alp, Ozen Osmanbasoglu, Ece Uzun (Istanbul, Turkey) Methods: Forty-five patients with pseudophakic retinal detachment were analyzed retrospectively. Patients with a final visual acuity greater than 0,1 (snellen equivalent) were defined as having a good visual prognosis. Parameters examined were age, gender, duration of the symptoms, preoperative visual acuity, preoperative intraocular...

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Topical Anesthesia in Posterior Vitrectomy with Sutureless Surgery

Hande Etus, Levent Karabas, Gulin Karaaslan, Yusuf Çaglar (Kocaeli, Turkey) Advantages: We initiated this prospective study to determine the safety and efficacy of topical anesthesia and its effect on surgical time in 23 G posterior vitrectomy. Methods: This study was comprised of 67 patients (73 eyes) scheduled for posterior vitrectomy using topical (35 eyes) (group 1) or retrobulbar (38 eyes) (group 2) anesthesia. Subjective pain and...

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Comparison of Clinical Outcomes Between Day Surgery and Overnight Admission Surgery in 23 Gauge Vitrectomy

Sungjin Na, Yongbaek Kim, Keunsung Park, Eunjung Lee, Eunkyoung Lee (Daejeon, South Korea) Advantages: To reduce patient’s cost and facilitate early rehabilitation in day surgery. Methods: After performing 23-gauge vitrectomy, we prospectively compared the 3-month follow-up results of day surgery cases (79 eyes) and 1-day admission cases (72 eyes). Effectiveness / Safety: Between 2 groups, improvement of best-corrected visual acuity...

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23 Gauge Primary Vitrectomy with Air Tamponade for Simple Rhegmatogenous Retinal Detachment

Sungjin Na, Yongbaek Kim, Keunsung Park, Eunjung Lee, Eunkyoung Lee (Daejeon, South Korea) Advantages: To reduce patient’s discomfort and hasten postoperative recovery. Methods: 38 eyes with simple rhegmatogenous retinal detachment underwent 23-gauge primary vitrectomy with air tamponade and without prone positioning by a single vitreoretinal surgeon. All cases were followed up for a minimum of 6 months after surgery. Effectiveness /...

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The Analysis of Efficacy of Surgical Treatment of Secondary Cataract in Patients with High-complicated Myopia by Usage of 25 Gauge Bi-port Transciliary Capsulevitrectomy

Mashchenko, Khudyakov, Zhigulin, Rudenko, Lebedev (Khabarovsk, Russia) Advantages: To study results of surgical treatment of secondary cataract by using 25G bi-port transciliary capsulevitrectomy in patients with high axial myopia. Methods: 43 patients (44 eyes) with high axial myopia and posterior lens capsule opacity of different degree were examined. There were paraoral and equatorial dystrophy in 23 eyes, myopic changes of posterior...

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Combined Cataract Extraction and Pars Plana Vitrectomy for Macular Sparing Rhegmatogenous Retinal Detachment Confirmed by Optical Coherence Tomography

Jung Yeul Kim (Daejeon, South Korea) Purpose: To evaluate visual outcomes of combined cataract extraction and pars plana vitrectomy for macula-sparing rhegmatogenous retinal detachment (RRD) with cataract. Methods: In patients with RRD and cataract in whom the macular are of 6,000 in diameter was not detached on the OCT, a retrospective analysis was performed to examine the results after combined vitrectomy/cataract extraction. Anatomic...

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Risk Factors of Iris Posterior Synechiae Formation After 23 G Sutureless Phacovitrectomy

Kuhl Huh, Seong-Woo Kim, Jaeryung Oh (Seoul, South Korea) Advantages: To identify the risk factors of posterior iris synechiae formation after 23G sutureless vitrectomy with clear cornea phacoemulsification and posterior chamber IOL implantation. Methods: Retrospective chart review was performed for patients treated with 23G phacovitrectomy by a single surgeon in a single center between March 2009 and February 2011. Various factors, such as...

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Combined Procedure with the « Bag-in-the-lens » Cataract Technique and Vitrectomy: The Future Standard Procedure?

Boris Rysanek (Caen, France) The “bag-in-the-lens” cataract technique was described in 2002 in Anvers by professor MJ Tassignon. It consists to realize a calibrated anterior and posterior capsulorhexis. Then, a specific IOL is injected and inserted into the two joined capsulorhexis. The vitrectomy is realized after the cataract. The advantages of this technique are the good visibility during the surgical operation, especially the lack...

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