This document discusses the surgical management of complications from proliferative diabetic retinopathy. It provides an overview of the pathogenesis and surgical treatment of tractional retinal detachment. Pars plana vitrectomy is the procedure of choice for treating vitreous hemorrhage and tractional retinal detachment. Advances in surgical instrumentation including illuminated instruments, wide-angle viewing systems, perfluorocarbon liquids, and smaller gauge vitrectomy cuts have improved surgical outcomes. The document reviews surgical techniques for removing fibrovascular membranes and achieving hemostasis.
Basic overview of phaco dynamics along with all the Newer phacoemulsification techniques available in current practice - a video-assisted the presentation
Basic overview of phaco dynamics along with all the Newer phacoemulsification techniques available in current practice - a video-assisted the presentation
WHAT WE SHOULD DO FOR PROGRESSIVE COMPLICATIONS OF PDR INSPITE OF “ADEQUATE” ...DrAbdelLatifsiam
PURPOSE
To draw attention to severe cases of Proliferative Diabetic Vitreo-Retinopathy which continue to progress, in spite of what was thought to be adequate laser treatment
WHAT WE SHOULD DO FOR PROGRESSIVE COMPLICATIONS OF PDR INSPITE OF “ADEQUATE” ...DrAbdelLatifsiam
PURPOSE
To draw attention to severe cases of Proliferative Diabetic Vitreo-Retinopathy which continue to progress, in spite of what was thought to be adequate laser treatment
Vitreous hemorrhage is the extravasation, or leakage, of blood into the areas in and around the vitreous humor of the eye.[1] The vitreous humor is the clear gel that fills the space between the lens and the retina of the eye. A variety of conditions can result in blood leaking into the vitreous humor, which can cause impaired vision, floaters, and photopsia.
It's an indepth presentation by Dr. Shah-Noor Hassan.
Complex cases in Cataract surgery and its management.pptxDrMadhumita Prasad
In ophthalmology the clinical management of patients is constantly evolving and complication rate is getting low.
Although routine cataract surgery considered as low-risk surgery for both patients and the surgeon, some eyes have higher risk of complications.
It is extremely important to recognize when eyes are at greater risk, and manage accordingly to reduce the complications.
The common goal is to completely remove the cataract while preserving the zonules and capsular bag for the placement of an IOL.
Fuchs’ endothelial corneal dystrophy (FECD) is a condition that affects the corneal endothelium, resulting in a reduction in the number of Na+/K+ ATPase pumps [1]. Clinically, this manifests as corneal edema, which can lead to symptomatic glare and halos, and ultimately decreased visual acuity.
Presentation- blurring of vision (more in the morning hours), glare.
Detection- guttae
Complex cases in Cataract surgery and its management.pptxMadhumitaBooks
Complex case scenarios in Cataract surgery. Small pupil , hard Cataract, posterior polar Cataract, Fuch's endothelial dystrophy, run away rhexis. Management of complicated Cataract.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Aaberg jr surgical management for diabetic retinopathy 2014
1. Surgical Management of Diabetic
Retinopathy
Thomas Aaberg Jr. M.D.
Retina Specialist of Michigan
Michigan State University
2. Management of complications
from Proliferative diabetic
retinopathy
Pars plana vitrectomy is the procedure
of choice for vitreous hemorrhage and
tractional retinal detachment
4. Pathogenesis Review:
Surgical Intervention for TRD
Hypoxia and angiogenic
factors, eg. VEGF
Neovascular and
fibrovascular proliferation
that extends from the
retina into the vitreous
cavity
Cycle of proliferation and
regression along the
posterior margin of
capillary non-perfusion
Vitreous Surgery. In Michels RG, Wilkinson CP and Rice TA eds. Retinal Detachment. St. Louis, 1990, Mosby, p. 814
5. Pathogenesis Review:
Surgical Intervention for TRD
Neovascular proliferation
usually begins:
at the optic nerve
along temporal
vascular arcades
mid-periphery at the
posterior margin of
capillary non-
perfusion
Vitreous Surgery. In Michels RG, Wilkinson CP and Rice TA eds. Retinal Detachment. St. Louis, 1990, Mosby, p. 814
6. Pathogenesis Review:
Proliferative Diabetic Retinopathy
Initially “bare”
Later, fibrous tissue appears
Vitreoretinal adhesions form
Cycle of proliferation and
regression
7. Pathogenesis Review:
Surgical Intervention for TRD
Growth of fibrovascular tissue is
dependent on posterior vitreous surface
Changes in vitreous occur, often resulting
in partial posterior vitreous detachment
Vitreous typically remains attached at
anterior retina/vitreous base and at each
area of fibrovascular proliferation
Vitreous Surgery. In Michels RG, Wilkinson CP and Rice TA eds. Retinal Detachment. St. Louis, 1990, Mosby, p. 815
8. Pathogenesis Review:
Surgical Intervention for TRD
Contraction of
fibrovascular tissue
growing along posterior
vitreous surface can cause
vitreous changes and
antero-posterior traction.
In the absence of vitreous
separation, widespread
adhesions to the retinal
surface may develop
Vitreous Surgery. In Michels RG, Wilkinson CP and Rice TA eds. Retinal Detachment. St. Louis, 1990, Mosby, p. 816
9. Pathogenesis Review:
Surgical Intervention for TRD
Contraction forces may
lead to:
Hemorrhage into vitreous
gel or preretinal space
Tractional retinal
detachment (TRD)
Distortion of retina/macula
Antero-posterior and
tangential traction
Traction on the optic nerve
Retinal tears
Vitreous Surgery. In Michels RG, Wilkinson CP and Rice TA eds. Retinal Detachment. St. Louis, 1990, Mosby, p. 816
13. Surgical Intervention for TRD
Purpose
Reverse pre-existing complications
causing visual loss
Alter course of retinopathy and remove
posterior vitreous surface
Vitreous Surgery. In Michels RG, Wilkinson CP and Rice TA eds. Retinal Detachment. St. Louis, 1990, Mosby, p. 816
14. Surgical Intervention for TRD
Posterior vitreous
surface is of great
importance in
pathogenesis and
complications of
proliferative
diabetic retinopathy
and must be
addressed during
vitreous surgery
Vitreous Surgery. In Michels RG, Wilkinson CP and Rice TA eds. Retinal Detachment. St. Louis, 1990, Mosby, p. 816
15. Surgical Intervention for TRD
Surgical objectives
Remove visually significant opacities
Excise posterior hyaloid
Remove and/or segment preretinal or
epiretinal fibrovascular tissue
Identify & treat retinal breaks
Hemostasis
Panretinal photocoagulation
Tamponade as needed
Vitreous Surgery. In Michels RG, Wilkinson CP and Rice TA eds. Retinal Detachment. St. Louis, 1990, Mosby, p. 816
16. DDiabetic
RRetinopathy
VVitrectomy
SStudy
A MultiA Multi--Center Collaborative Clinical TrialCenter Collaborative Clinical Trial
Supported by Contracts fromSupported by Contracts from
The National Eye InstituteThe National Eye Institute
PortlandPortland
San FranciscoSan Francisco
Los AngelesLos Angeles
MinneapolisMinneapolis
MadisonMadison
ChicagoChicago
MilwaukeeMilwaukee
DetroitDetroit
AlbanyAlbany
BostonBoston
New YorkNew York
PhiladelphiaPhiladelphia
BaltimoreBaltimore
DurhamDurham
AtlantaAtlanta
MiamiMiami
17. More rapid recovery of useful vision (important if fellow eye
has poor vision)
Greater chance for recovery of good vision (at least Type I DM
who were younger and had more severe PDR)
Suggestive increase in frequency of NLP in Type II and mixed
DM groups (older patients with less PDR)
Early Vitrectomy in Eyes with
Recent Severe Diabetic Vitreous
Hemorrhage
18. Diabetic Retinopathy
Vitrectomy Study
Eyes (n = 370) with fibrovascular
proliferation and 20/400 or better VA
Results: 20/40 or better VA at 4 years
Early surgery: 44% eyes
Deferred surgery: 28% eyes
Early Vitrectomy for Severe Proliferative Diabetic Retinopathy in Eyes with Useful Vision. Results of a Randomized Trial-
-. Diabetic Retinopathy Vitrectomy Study (DRVS) report #3. Ophthalmol 1988; 95(10):1307-1320
19. Results of Vitrectomy for
diabetic TRD involving macula
Improved VA: 26% - 72% cases
Vitreous Surgery. In Michels RG, Wilkinson CP and Rice TA eds. Retinal Detachment. St. Louis, 1990, Mosby, p. 824-825
20. Results of Vitrectomy for combined
diabetic TRD and rhegmatogenous
detachment
Retinal reattachment: 80%
Improved Vision: 50%
Rates of success can vary
based on patient
population, pathology and
access to health care
Vitreous Surgery. In Michels RG, Wilkinson CP and Rice TA eds. Retinal Detachment. St. Louis, 1990, Mosby, p. 825
Photo courtesy of Edgar L. Thomas, MD
23. Advanced Diabetic Vitrectomy
Begins Pre-operatively
Maximize systemic health/stability
Concentrate on renal status
Work with primary care physician,
endocrinologist, nephrologist
Properly educate patient
Pathophysiology
Extent of disease
Proper patient expectations
24. Immediate Pre-Operative
Anti-VEGF … Yes or No
Literature supporting
both pro and con
Personally I use IF:
I know the patient will be
compliant
I know the surgical case is
a GO
There is active NV not just
traction or hemorrhage.
25. Why be concerned about anti-
VEGF use?
Immediate concern:
Delayed surgery may
lead to progressive
severe vitreoretinal
contraction
Longer term concern:
Rebound proliferation
once anti-VEGF effect
dissipates.
26. Step 2: Surgical Planning
Game changing advances in
surgical instrumentation.
27. Surgical Planning/Decisions
Anesthesia: General vs Local
Gauge: 20 vs 23 vs 25 vs 27
Lens disposition
Pseudophakic
Phakic
Unencumbered view of pathology
Compromises view
Keep or remove the lens with or without an IOL
Bimanual versus “uni”-manual approach
28. Chosen Surgical Gauge was largely
dictated by number of available
instruments
Vitrectomy probes
High speed cutters
Different edge profiles
20 gauge
20 gauge
25 gauge
25 gauge
35. Illuminated instrumentation and
chandeliers … a critical advance
20 gauge chandelier and set-up
Illuminates one area preferentially
Photos courtesy of Synergetics and James Andrews
37. Another critical surgical advance:
Perfluorocarbon Liquid
Properties
Non-toxic
Clear liquid
High density
Low viscosity; easy
to inject and remove
Visualize liquid
interface
Volatility
38. Perfluorocarbon Liquid:
The Third Hand
Benefits
Keep heme off
macular region
Assist in dissection
and removal of
posterior hyaloid
Stabilize the retina
during membrane
dissection and
delamination
39. Perfluorocarbon Liquid:
The Third Hand
Benefits
Identify residual
posterior hyaloid
and membranes
Drain subretinal
fluid through
peripheral break
Allow for
controlled
retinotomies
40. Perfluorocarbon Liquid:
The Third Hand
Complications
Subretinal PFC may pass through posterior
breaks with traction
Residual PFC at end of surgery
more common in hemorrhages
41. Advances in Surgical Instrumentation:
Wide Angle Viewing
Contact
AVI
Volk
Noncontact
BIOM
Merlin
42. Advances in Surgical Instrumentation
Wide Angle Viewing
Benefits
Improved panoramic visualization
More easily visualize extent of tractional forces
Improved management of peripheral retinal
pathology
Bimanual surgery
Enhances phakic fluid air exchange and
placement of scatter laser treatment
45. Bimanual Surgery
Endo-illumination by chandelier
Single chandelier
Dual chandelier
Illuminated infusion cannula
Illuminated instruments
46. Surgical Intervention for TRD
Surgical Techniques
Vitrectomy
Remove core vitreous
Incise posterior vitreous surface
Relieve A-P traction
Vitreous Surgery. In Michels RG,
Wilkinson CP and Rice TA eds. Retinal
Detachment. St. Louis, 1990, Mosby, p.
816-817
47. Surgical Techniques for surface
membranes
Segmentation
Divide fibrovascular tissue
Vitreous Surgery. In Michels RG, Wilkinson CP
and Rice TA eds. Retinal Detachment. St. Louis,
1990, Mosby, p. 816-824
48. Surgical Techniques for surface
membranes
En bloc
Use some posterior vitreous A-P traction
to elevate edge of fibrovascular tissue
Diagrams from Gardner
TW and Blankenship GW.
Proliferative diabetic
retinopathy: principles
and techniques of surgical
treatment. In Ryan SJ ed.
Retina, Bert Glaser, ed.
Vol 3 Surgical Retina. St.
Louis, 1994, Mosby, p.
2420-2421
49. Surgical Techniques for surface
membranes
Modified En Bloc
Delamination
After releasing
pathology from
the vitreous base,
use an instrument
to induce A-P
traction and create
a cleavage plane.
50. Surgical Techniques for surface
membranes
Modified En Bloc
Delamination
Identify cleavage plane
Scissors to transect
fibrovascular bridges
Hemostasis
Endodiathermy or
bipolar diathermy
PRP
Tamponade as needed
52. Surgical Intervention for TRD
First-Is it necessary?
Break
No-breaks
Second-Which
agent?
Air
SF6
C3F8
Silicone oil
Monocular
Aphakia
53. Tamponade
Factors relevant to
tamponade agent
Extent of pathology
Patient
compliance/physical
abilities
Lens Status
Monocular vs
Binocular
Travel
54. Surgical intervention for TRD
Major Complications
Retinal tears
Retinal detachment
PVR
Cataract
Endophthalmitis
Vitreous Surgery. In Michels RG, Wilkinson CP and Rice TA eds. Retinal Detachment. St. Louis, 1990, Mosby, p. 825