http://www.tvrs.gr/

1. ATHANASIOS NIKOLAKOPOULOS
THESSALONIKI-GREECE
anikolako@yahoo.gr
THIRD INTERNATIONAL FORUM OF OPHTHALMIC SURGERY

3. 1. Neovascular tissue is bleeding
2. Tractional tears can be away from the working area
3. Retina and membranes can be as one tissue
4. Mobility of a ”thin”detached retina
5. Heavy laser,has prodused atrophic scars that open up

4. Severe hemorrhages
Iatrogenic untreated tears
Postop persistent retinal detachment -
neovascular glaucoma

6. 1. Stiffer instruments
2. Duty cycle
3. Port wider (closer to retina surface)
4. IOP control + VGFI
5. Controlled vacum
6. Higher flow rate
7. 5000cpm – less traction
8. Control linear reflux (wash out)
9. Control linear extrusion
10. Simultaneous two step exchange of PFCL - air -
silicone oil 5700cts

7. 4 PORT 25G VITRECTOMY

8. Always bimanual surgery (25-27 chandelier
light)
 always wide angle observation systems (non
contact)

9. 1) Lift, detect and cut (5000cpm, 600 vacum) under visual
control (NO SCISSORS). Dissecting in order to have
only single traction direction
2) Exchange of fluid – air – 5700cts silicone oil under
direct visualization. (air infusion is on 20mmHg and the
silicone oil injection on 60psi)
3) Soft tip blood evacuation, IOP controlling hemorrhage
4) Curved laser probe to reach the periphery
5) Usually no sutures needed at the end

10. 120 cases using 25G single hand vitrectomy without the
use of current evolution tecnologies.
142 cases using bimanual 25G with the current evolution
systems and 5700cts silicone oil injection in the last two
years.
RESULTS
35% less iatrogenic tears
50% better visual outcome after silicone oil removal
40% less postop early rebleeding.

11. 1. A new concept for vitreous surgery. 7 . Two instrument
techniques in pars plana vitrectomy. Machemer R. Arch
Ophthalmol. 1974.
2. Four port bimanual vitrectomy. Gaynon MW, Schepens
CL, Hirose T. Arch Ophthalmol. 1986.
3. Temporary Silicone oil tamponade in the treatment of
complicated diabetic retinal detachments. Gonvers M.
Graefes Arch Clin Exp Ophthalmol. 1990.

12. THANK YOU