Nikolakopoulos esaso traction rd
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This document discusses techniques for vitreous surgery using 25G instruments. It describes how bimanual 25G vitrectomy allows for simultaneous control of two instruments with better visual control compared to single hand vitrectomy. The techniques emphasized include lifting and cutting membranes under direct visualization, simultaneous fluid-air-silicone oil exchange, soft tip evacuation to control hemorrhage, and peripheral laser treatment. The author reports results from 142 cases using these 25G bimanual techniques showing 35% fewer iatrogenic tears, 50% better vision after silicone oil removal, and 40% less early rebleeding compared to earlier cases using single hand 25G vitrectomy.
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1) Trabeculectomy is a glaucoma surgery that creates an opening in the eye to drain fluid from the anterior chamber and reduce intraocular pressure.
2) It involves making a partial thickness scleral flap, removing a block of tissue underneath, and suturing the flap loosely to allow fluid drainage.
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At the end of the presentation audience participants became familiar with the main benefits and risks of currently available glaucoma treatments as well as had awareness of the most promising potential future surgical glaucoma treatments.
This OD CE Course was held at Green Street Tavern, Pasadena, CA last May 20, 2015.
=========================
[Glaucoma Surgeon, California] Dr. David Richardson is a board certified Ophthalmologist and Eye Surgeon in California specializing in the treatment of Cataract and Glaucoma. He is the Medical Director of San Marino Eye (Vision Center), located in San Marino, California. He’s the former Chief of Surgery and now Vice Chief of Staff at San Gabriel Valley Medical Center. Dr. Richardson has performed thousands of advanced cataract and Canaloplasty glaucoma procedures with excellent results.
More information about Dr. Richardson: http://David-Richardson-MD.com
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More information about new glaucoma treatments here: http://new-glaucoma-treatments.com
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This document discusses various techniques for repairing retinal detachments, including cryotherapy, laser photocoagulation, pneumatic retinopexy, scleral buckling, and vitrectomy. Cryotherapy uses temperature to induce inflammation and seal retinal breaks, while laser photocoagulation uses targeted burns. Pneumatic retinopexy employs an intravitreal gas bubble. Scleral buckling places an explant on the sclera to push the retina back into position. Vitrectomy surgically removes the vitreous gel to relieve traction on retinal breaks. Each technique has benefits and risks, and the optimal approach depends on factors like break location and extent of detachment. Advances in small-gauge
Management of retinal detachment....
This document provides information on the management of retinal detachment. It begins with definitions of key terms like scleral buckling and the various surgical procedures used to reattach the retina like scleral buckling, vitrectomy, and pneumatic retinopexy. It then describes the surgical steps for procedures like scleral buckling in 3 sentences or less, including conjunctival peritomy, slinging the rectus muscles, cryotherapy or retinopexy, placement of explants and sutures, and drainage of subretinal fluid. The document also summarizes techniques for pneumatic retinopexy including use of gases like sulfur hexafluoride and properties of silicone oil used as an
Surgery in open angle glaucoma
Surgeries for open angle glaucoma were discussed, including trabeculectomy. Trabeculectomy involves making a conjunctival flap, applying antimetabolites, excising a block of tissue from the eye, and suturing the scleral flap. Potential complications include shallow anterior chamber, low or high eye pressure, infection, and visual loss. Careful postoperative monitoring and treatment are important to manage complications while lowering eye pressure to prevent further glaucoma damage.
Scleral buckling for rhegmatogenous retinal detachment
Scleral buckling surgery involves suturing a silicone implant or explant to the outer layer of the eye (sclera) to push the retina back into contact with the retinal pigment epithelium. This is done by creating an inward indentation of the sclera. The implant seals retinal breaks by approximating the retina and RPE over the buckle. Key steps include identifying retinal breaks, treating the breaks with cryotherapy or laser, placing scleral sutures, and sometimes draining subretinal fluid. The goal is to close breaks and reduce traction on the retina to allow it to reattach.
INTERFACE VITRECTOMY UNDER SILICONE OIL -AJAY DUDANI
This document describes interface vitrectomy, a surgical technique used to treat recurrent retinal detachment. It involves operating at the interface between vitreoretinal tissues and substances like silicone oil. The key steps include peeling any epiretinal or peripheral membranes using a microhook needle, draining subretinal fluid through a retinotomy, and topping off existing silicone oil through one vitrectomy port. The modified 2-port technique causes less trauma than standard repeat surgery. In a case series of 15 patients, most had improved vision with retinas attached after interface vitrectomy despite some complications. The technique is effective for recurrent detachment with proliferative vitreoretinopathy.
High Frequency Deep Sclerotomy (HFDS)
This document provides information on High Frequency Deep Sclerotomy (HFDS) surgery for glaucoma. It describes HFDS as a minimally invasive glaucoma surgery that bypasses the trabecular meshwork by using a high frequency probe to create multiple sclerotomies, allowing aqueous humor to drain directly into Schlemm's canal. The document discusses the surgical procedure for HFDS and presents a case study demonstrating reduced intraocular pressure following the surgery. It also compares HFDS to other glaucoma surgeries such as trabeculectomy and reviews their respective success rates and complication profiles.
Vitreoretinal complications during transition to flacs
This document discusses femtosecond laser-assisted cataract surgery (FLACS). It describes how femtosecond lasers work using ultrashort pulses to precisely cut tissue with minimal collateral damage. The major advantages of FLACS include reduced ultrasound energy needed for phacoemulsification and more precise capsulotomies and incisions. However, risks include increased anterior capsule tears due to the learning curve. The document also discusses techniques for managing complications like posterior capsule rupture, including performing limited anterior vitrectomy through the capsular opening or pars plana vitrectomy ports.
Vitreoretinal complications during transition to FLACS
This document discusses femtosecond laser-assisted cataract surgery (FLACS). It describes how femtosecond lasers work using ultrashort pulses to precisely cut tissue with minimal collateral damage. The major advantages of FLACS include reduced ultrasound energy needed for phacoemulsification and more precise capsulotomies and incisions. However, risks include increased anterior capsule tears due to the learning curve. The document also discusses techniques for managing complications like posterior capsule rupture, including performing limited anterior vitrectomy while maintaining a closed system to minimize vitreous loss.
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Rhegmatogenous Retinal Detachment --RRD
This document discusses retinal detachment, including the different types, causes, evaluation, and surgical treatment options. It covers rhegmatogenous retinal detachment caused by retinal breaks, as well as exudative retinal detachment due to fluid leakage. Surgical techniques mentioned include scleral buckling, pneumatic retinopexy using an expansile gas, vitrectomy, and the use of tamponading agents like gases, silicone oil, and the Lincoff balloon. Complications and failure rates of the procedures are also summarized.
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CATARACT SURGERY COMPLICATIONS
Early complications of intraocular lens (IOL) surgery include corneal edema, wound leak, shallow anterior chamber, hyphaema, retained lens matter, and uveitis. Late complications include posterior capsular opacification, cystoid macular edema, endophthalmitis, and retinal detachment. Post-operative endophthalmitis is a vision-threatening complication that is treated with topical, systemic, and intravitreal antibiotics along with steroids. Posterior capsular opacification occurs in 10-50% of cases due to proliferation of lens epithelial cells.
Corneal surgery
This document discusses corneal surgery, including corneal refractive surgery and corneal transplant surgery. It describes the different types of corneal refractive surgery, which include flap surgery techniques like LASIK as well as surface procedures like PRK. Corneal transplant surgery, also called keratoplasty, is described as replacing damaged corneal tissue with donor tissue. The different types of keratoplasty like penetrating keratoplasty and lamellar keratoplasty are mentioned. The document provides details on donor corneal preparation and storage, surgical techniques, potential complications, and post-operative care for corneal transplant surgery.
Corneal surgery
This document discusses corneal surgery, including corneal refractive surgery and corneal transplant surgery. It describes the different types of corneal refractive surgery, which include flap surgery techniques like LASIK and surface procedures like PRK. Corneal transplant surgery, also called keratoplasty, is described as replacing damaged corneal tissue with healthy donor tissue. The common techniques used are penetrating keratoplasty and lamellar keratoplasty. The document outlines the donor corneal preparation and storage methods, as well as the surgical techniques and potential complications of corneal transplant surgery.
Malignant glaucoma
Classic malignant glaucoma is a rare complication of incisional surgery for angle-closure glaucoma where the anterior chamber shallows due to forward movement of the iris-lens diaphragm despite increased intraocular pressure. It can occur in eyes with or without glaucoma and may be triggered by laser treatment, miotics, or trabeculectomy. Treatment involves reducing pressure and vitreous volume medically or surgically with vitrectomy. Definitive management is phacoemulsification, intraocular lens implantation, and removal of the posterior capsule during vitrectomy.
MIGS
This document summarizes minimally invasive glaucoma surgery (MIGS) procedures. MIGS offers more modest intraocular pressure (IOP) lowering than traditional glaucoma surgery, but with a safer risk profile. The document describes various MIGS procedures including the iStent, Hydrus, CyPass, and XEN gel stent. It provides details on the mechanism of action, surgical technique, efficacy and safety data from clinical studies for each procedure. MIGS provides an alternative treatment option for glaucoma patients to lower IOP and reliance on eye drops without the risks of more invasive surgeries.
Manual small incision cataract surgery
Manual small incision cataract surgery (MSICS) is presented as a lower cost alternative to phacoemulsification for cataract removal. MSICS involves making a 5.5mm scleral incision and using manual techniques to express the nucleus through the incision without ultrasound. The procedure is described in 18 steps, including continuous curvilinear capsulorrhexis, hydrodissection, and expression of the nucleus. MSICS provides many advantages of modern cataract surgery like rapid recovery time and minimal induced astigmatism at a lower cost than phacoemulsification by using simpler equipment and techniques.
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Ripandelli the author has no potential
1. The study examines vitreoretinal interface modifications in highly myopic eyes with posterior staphyloma over a 5-year follow up period.
2. 214 eyes were included and classified into 5 groups based on anatomical changes observed. The most common finding was epiretinal membrane without retinal changes (45.7% of eyes).
3. Evolution requiring surgery occurred in 11.7% of eyes, with various surgical approaches used depending on the classification group.
4. Vitreoretinal alterations in highly myopic eyes represent a spectrum of conditions that are not fully classified, and disease progression and surgical timing remain uncertain and need standardization.
Ripandelli posterior buckling for macular hole
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This document discusses surgical techniques for treating retinal detachment in highly myopic eyes, specifically posterior buckling procedures. It describes the pathogenesis of retinal detachment in high myopia, which is often caused by persistent adherence of rigid epiretinal tissue and retinal/choroidal defects in the staphyloma area. Both posterior buckling and vitrectomy are discussed as surgical options, with buckling recommended for cases with severe staphylomas, pronounced retinal schisis, or when epiretinal membranes cannot be easily cleaved from the retina during vitrectomy. The posterior buckling procedure and silicone buckle element are described in detail. In conclusions, vitrectomy is primarily recommended but buckling may be useful asReppucci retinotmoy resection tvrs
This document discusses retinotomies and vitreous base resection during retinal detachment surgery. It defines a retinotomy as an iatrogenic opening in the retina, which can be used for drainage, subretinal access, or relaxing traction. The role of the inferior vitreous base in proliferative vitreoretinopathy and recurrent detachment is described. A technique for resection of the inferior vitreous base during surgery is presented, which may reduce redetachment rates compared to non-resection, though carries risks if not performed carefully. Retinotomies can be useful, but require complete removal of surrounding traction; resection is not a shortcut and risks retinal loss if too aggressive.
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This document discusses various tumors and pseudotumors that can affect the optic disc, including congenital anomalies, pigmented tumors, tumors of the retinal pigment epithelium, vascular tumors, glial tumors, primary retinal tumors, and tumors invading from other sites. It provides examples of specific conditions like melanocytoma, hemangioblastoma, astrocytic hamartoma, and retinoblastoma. Diagnostic testing and treatment approaches are mentioned for some conditions. The conclusion emphasizes that while various tumors can involve the optic disc, most of these conditions are rare.Zografos anti veg fs in ocular oncology
This document summarizes a presentation on using intravitreal anti-VEGF drugs to treat complications from ocular oncology and radiation therapy. It discusses using anti-VEGF drugs to treat choroidal metastases, vascular tumors, choroidal nevi, radiation-induced optic neuropathy, retinopathy, maculopathy, neovascular glaucoma, and retinal detachment. Case studies and outcomes are presented for various conditions treated with anti-VEGF drugs. The conclusion is that intravitreal anti-VEGF injections show promise for managing complications of radiation therapy for uveal melanomas.
Parikakis the setup of advanced vr course
The document describes an advanced VR (vitreoretinal) surgery course that includes:
1) Theory sessions and wetlab practice using modern vitrectomy units with microincisional surgery options.
2) Practice using pig eyes, synthetic eye models, and a computerized training simulator.
3) Steps for wetlab vitrectomy practice and simulator training are outlined.
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Ovali diabetic retinopathy laser treatment anti vegf
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This document discusses treatments for diabetic retinopathy, including laser treatment and anti-VEGF drugs. It provides details on panretinal laser photocoagulation to treat peripheral retinal ischemia and grid laser photocoagulation to treat macular edema. It also discusses various anti-VEGF drugs like bevacizumab, ranibizumab, and aflibercept that are administered via intravitreal injections to treat diabetic retinopathy. Complications of different treatments and diagnostic tools are also mentioned. Clinical trial results comparing anti-VEGF drugs and laser therapy are summarized.Ovali bimanual transconjunctional virectomy
This document discusses bimanual transconjunctival vitrectomy surgery. It describes how bimanual surgery, using two instruments simultaneously through two cannulas, facilitates procedures like diabetic tractional membrane excision and peripheral vitrectomy. Bimanual surgery allows for stronger chandelier lighting and more control of the peripheral retina compared to traditional single-port vitrectomy. The document also notes that bimanual vitrectomy can make surgery safer, shorter, and help prevent overlooked peripheral complications.
Nikolakopoulos vitrectomy or microplasmin in dme with vitreomacular traction
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Diabetic macular edema (DME) is a major cause of vision loss in people with diabetes. DME affects up to 25% of people after 10 years of diabetes diagnosis and over 40% of people with type 1 diabetes in their lifetime. Current treatment options for DME include laser photocoagulation, anti-VEGF agents, and combined therapy of laser photocoagulation and anti-VEGF agents. Vitrectomy may improve outcomes for DME when there is also macular traction present. A new potential treatment, ocriplasmin, is an enzyme designed to cleave the vitreoretinal interface and has shown promise in resolving vitreomacular adhesion in early clinical trials without requiringNikolakopoulos hydrolifting in cortical vitreous attachments
Nikolakopoulos hydrolifting in cortical vitreous attachmentsThessaloniki International Vitreo-Retinal Summer School
This document discusses techniques for removing cortical vitreous attachments during vitrectomy surgery. It notes that vitreoschisis, or splitting within the posterior vitreous cortex, occurs in 59.5% of cases involving macula interface pathology. 18% of cases show resistant macula attachments that require more than just suction to remove. The document describes different types of vitreoschisis seen during surgery and introduces the technique of hydrolifting to create space for safely lifting resistant cortical vitreous. This involves proportionally refluxing balanced salt solution at the edges using a probe or injecting it using a needle to lift the attachments. Ocriplasmine injection before surgery is also discussed for refractory casesNikolakopoulos fundamentals and principals of oct
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OCT was first reported in 1991 and used to image the retina starting in 1993. OCT uses infrared light to generate high-resolution, cross-sectional images of the retina. It provides an "optical biopsy" and allows examination of individual retinal layers. Early time-domain OCT had lower resolution and scan rates than modern spectral-domain OCT, which can achieve over 50,000 scans per second and resolutions of 5-7 micrometers. OCT is a valuable tool for examining retinal pathology and monitoring treatment outcomes in a non-invasive manner.Nikolakopoulos esaso
This document discusses the benefits of bimanual primary vitrectomy using 25+ and 27G instrumentation for retinal detachment repair. Key benefits include safer shaving and manipulations close to the retina thanks to an additional surgical hand. The document also highlights techniques like simultaneous infusion/extrusion and oil/fluid exchange that can be performed under direct visual control using two hands. Finally, it notes that 27G probes allow for delicate manipulations near the retinal surface while causing less hypotony and obscuration compared to older 25G instruments.
Nikolakopoulos esaso hydro
This document discusses different types of vitreous attachments seen during vitrectomy surgery, specifically cortical vitreous attachments near the macula. The author observed these attachments in 59.5% of cases performed for macular interface pathology. 18% of cases showed highly resistant macular attachments that required additional techniques beyond simple suction to remove. One such technique, called hydrolifting, uses regulated irrigation of balanced salt solution at the edges of resistant cortical vitreous attachments to gently lift the vitreous and create space for safe removal near sensitive tissues like the macula and disc. For the most refractory 18% of cases, ocriplasmine injection before surgery may also help with vitreous detachment.
Nikolakopoulos 25+ 27 g evolution in bimanual primary vitrectomy for rd
Nikolakopoulos 25+ 27 g evolution in bimanual primary vitrectomy for rdThessaloniki International Vitreo-Retinal Summer School
This document summarizes key aspects of chandelier endoillumination techniques for vitrectomy surgery. It discusses refinements in surgical instruments, wide-angle viewing systems, and endoillumination systems that have driven increased use of minimally invasive vitrectomy surgery (MIVS). Specific chandelier fibers and instrumentation from various manufacturers are presented. Tips for optimizing chandelier illumination settings are provided from literature references. Enhancements in tissue visualization through dye staining, gas/oil use, and color filters are discussed. The evolution of higher resolution probes and need for adequate illumination with smaller gauges is summarized. Considerations for patient selection with ocriplasmin treatment are highlighted.Kranias diagnostic challenges in retinal diseases 06 20 14
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This document discusses several cases that presented with retinal pathologies that served as initial signs of underlying systemic diseases:
1) A woman with blurred vision was diagnosed with systemic lupus erythematosus based on anemia and autoantibodies.
2) A man with reading difficulty had Waldenstrom's macroglobulinemia indicated by increased serum viscosity and IgM levels.
3) A young woman with vision loss had acute myeloid leukemia shown by abnormal blood counts and blasts.
4) Retinal pathologies can indicate serious underlying conditions like cancer, requiring thorough workup.Guarnaccia grecia gg giugno 2014
This document provides information about the European School for Advanced Studies in Ophthalmology (ESASO). It summarizes that ESASO was founded in 2008 in Switzerland as an independent foundation to provide post-graduate ophthalmology education. It offers modules and fellowships to train ophthalmologists. Between 2009-2014, ESASO held 35 modules that graduated over 900 students from Europe, Asia, the Middle East, South America, Africa, and Australia. ESASO also offers 4 types of fellowships for further subspecialty training. The document discusses ESASO's vision, mission, students, modules in 2014, graduations from 2010-2013, and fellowships. It provides an overview of ESASO
Pournaras vitreoretinal surgical management
This document discusses surgical techniques for managing uveal melanoma, including tumor resection after proton beam therapy and ocular biopsy. It describes three treatment goals of tumor control, eye retention probability, and functional results. Proton beam radiotherapy provides high local tumor control rates but can cause complications like radiation retinopathy. Secondary tumor resection via endoresection may be needed to manage complications like toxic tumor syndrome. Ocular biopsy techniques like transcleral, transvitreal, and fine needle aspiration are described for obtaining tumor samples for diagnosis and molecular analysis. Risks and indications for each biopsy method are outlined.
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Parikakis 1 tvr scoursepcataractcomplications 2014Thessaloniki International Vitreo-Retinal Summer School
This document discusses treating complications that can occur during cataract surgery or with intraocular lenses (IOLs). It outlines techniques for managing complications like capsular rupture, dropped nuclei, IOL dislocation, endophthalmitis, and iris trauma. For IOL exchange in an open posterior capsule, it recommends controlling the environment, maintaining capsule integrity, using ocular viscoelastic devices, inserting the new IOL before removing the old one, and choosing a 3-piece acrylic IOL for sulcus implantation. For endophthalmitis, treatments include vitrectomy, intravitreal antibiotics, subconjunctival injections, and fortified topical drops depending on visual acuity. The document provides technicalForlini iol gold standard quatar 2010 tiblis 12
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The document discusses the "gold standard" of secondary intraocular lens (IOL) implantation in the era of minimally invasive vitreoretinal surgery (MIVS). It describes scleral fixation and iris-claw IOLs as options for secondary IOL implantation when capsular support is absent. The iris-claw IOL implanted in the posterior chamber is presented as the author's preferred approach, as it avoids opening the conjunctiva and allows changing the surgical approach. Experience with over 200 posterior iris-claw IOL implantations is discussed, with low rates of complications like spontaneous luxation. The minimally invasive, transconjunctival approach is advocated for the treatment of cataract surgeryMore from Thessaloniki International Vitreo-Retinal Summer School (20)
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Nikolakopoulos esaso traction rd
- 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