Proliferative diabetic retinopathy
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a plaser photoablation is more than often a definitve solution for retinal new vessels What to do when it s not?
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OCT ANGIOGRAPHY
OCT Angiography provides a new non-invasive method to visualize retinal vessels without intravenous dye. It produces higher resolution images than traditional OCT, detecting even trace amounts of exudation. However, questions remain about how to interpret and clinically apply the additional information it provides. While it can detect exudation earlier and show incomplete resolution with treatment, the implications of persistent or recurrent exudation seen on OCT Angiography are still unclear. This specific patient has barely perceptible exudation on routine OCT but cysts and fluid are visible on OCT Angiography. It is uncertain whether treatment is required given her good vision and lack of symptoms.
OCT ANGIOGRAPHY
OCT Angiography provides a new way to visualize retinal vessels without intravenous dyes, potentially replacing invasive dye-based angiography. While higher resolution imaging from OCT Angiography detects even subtle exudation not seen on standard OCT, it is unclear if treating based on this additional detected exudation would improve outcomes for patients. Further studies are needed to understand the natural history of persistent exudation and determine the proper treatment threshold. In this case, OCT Angiography detected trace fluid in a patient with no symptoms, leaving the decision of whether to treat less clear.
Optovue OCT-A quick review
This document provides a summary of Optovue's OCT-Angiography device called RTVue XR (Avanti). It discusses the company background, key specifications and innovations of the device. The device uses Split Spectrum Amplitude Decorrelation Algorithm and Motion Correction Technology to perform OCT Angiography and visualize the microvasculature of the retina. It allows for quantification of parameters like non-perfusion areas, vessel density and neovascularization areas. Future software upgrades are expected to provide 3D microvascular visualization and wider scan areas.
Oct angiography
OCT Angiography is a novel and non-invasive imaging
technique to visualize the microvascular network
Macular hole
This document provides an overview of macular holes, including:
- Classification into primary (idiopathic) and secondary holes. Primary holes are caused by vitreous traction while secondary have other causes like trauma.
- Stages of macular hole formation based on Gass classification from early detachment to full thickness hole.
- Surgical treatment involves vitrectomy to relieve traction along with internal limiting membrane peeling which has good outcomes in improving vision.
- Differential diagnosis includes epiretinal membranes and pseudoholes which have different presentations and prognoses.
Spectralis oct normal anatomy & systematic interpretation.
This document provides guidance on interpreting optical coherence tomography (OCT) scans of the retina. It begins by outlining key principles, such as utilizing fundus images and understanding the significance of OCT findings. It then details a 5-step process for evaluating scans: 1) assessing scan quality, 2) rating the overall retinal profile, 3) evaluating the foveal profile, 4) identifying any foveal cut, and 5) carrying out a structural assessment. This includes observing layer alterations, identifying additional structures, and using standardized terminology to describe pathological features. Key pathological structures and findings are defined, including changes affecting the retinal pigment epithelium, sub-RPE space, and intraretinal and subretinal spaces.
Glaucoma and OCT – Are Macula Scans More Valuable than Disc Scans
This document discusses the use of optical coherence tomography (OCT) for diagnosing and monitoring glaucoma. It suggests that macula scans may be more valuable than disc scans due to being more repeatable and reliable. It also discusses using ganglion cell complex thickness measurements and progression analysis on OCT to detect damage earlier than visual field tests. Additional techniques like electroretinography and visual evoked potentials can detect even earlier changes in the visual system to aid in glaucoma diagnosis and monitoring treatment effectiveness.
NW2010 Macular hole
This document provides an overview of macular holes (MH), including their epidemiology, pathogenesis, classification, diagnosis, natural course, treatment, and outcomes. Some key points:
- MHs are full-thickness defects in the macula that result in central vision loss. The most common cause is idiopathic vitreous traction.
- MHs are classified into 4 stages based on size and the presence of a posterior vitreous detachment. Stage 3 holes over 400 microns rarely close spontaneously.
- Treatment involves pars plana vitrectomy to relieve vitreous traction, with or without internal limiting membrane peeling. An air-gas bubble or silicone oil is used to tampon
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OCT ANGIOGRAPHY
OCT Angiography provides a new non-invasive method to visualize retinal vessels without intravenous dye. It produces higher resolution images than traditional OCT, detecting even trace amounts of exudation. However, questions remain about how to interpret and clinically apply the additional information it provides. While it can detect exudation earlier and show incomplete resolution with treatment, the implications of persistent or recurrent exudation seen on OCT Angiography are still unclear. This specific patient has barely perceptible exudation on routine OCT but cysts and fluid are visible on OCT Angiography. It is uncertain whether treatment is required given her good vision and lack of symptoms.
OCT ANGIOGRAPHY
OCT Angiography provides a new way to visualize retinal vessels without intravenous dyes, potentially replacing invasive dye-based angiography. While higher resolution imaging from OCT Angiography detects even subtle exudation not seen on standard OCT, it is unclear if treating based on this additional detected exudation would improve outcomes for patients. Further studies are needed to understand the natural history of persistent exudation and determine the proper treatment threshold. In this case, OCT Angiography detected trace fluid in a patient with no symptoms, leaving the decision of whether to treat less clear.
Optovue OCT-A quick review
This document provides a summary of Optovue's OCT-Angiography device called RTVue XR (Avanti). It discusses the company background, key specifications and innovations of the device. The device uses Split Spectrum Amplitude Decorrelation Algorithm and Motion Correction Technology to perform OCT Angiography and visualize the microvasculature of the retina. It allows for quantification of parameters like non-perfusion areas, vessel density and neovascularization areas. Future software upgrades are expected to provide 3D microvascular visualization and wider scan areas.
Oct angiography
OCT Angiography is a novel and non-invasive imaging
technique to visualize the microvascular network
Macular hole
This document provides an overview of macular holes, including:
- Classification into primary (idiopathic) and secondary holes. Primary holes are caused by vitreous traction while secondary have other causes like trauma.
- Stages of macular hole formation based on Gass classification from early detachment to full thickness hole.
- Surgical treatment involves vitrectomy to relieve traction along with internal limiting membrane peeling which has good outcomes in improving vision.
- Differential diagnosis includes epiretinal membranes and pseudoholes which have different presentations and prognoses.
Spectralis oct normal anatomy & systematic interpretation.
This document provides guidance on interpreting optical coherence tomography (OCT) scans of the retina. It begins by outlining key principles, such as utilizing fundus images and understanding the significance of OCT findings. It then details a 5-step process for evaluating scans: 1) assessing scan quality, 2) rating the overall retinal profile, 3) evaluating the foveal profile, 4) identifying any foveal cut, and 5) carrying out a structural assessment. This includes observing layer alterations, identifying additional structures, and using standardized terminology to describe pathological features. Key pathological structures and findings are defined, including changes affecting the retinal pigment epithelium, sub-RPE space, and intraretinal and subretinal spaces.
Glaucoma and OCT – Are Macula Scans More Valuable than Disc Scans
This document discusses the use of optical coherence tomography (OCT) for diagnosing and monitoring glaucoma. It suggests that macula scans may be more valuable than disc scans due to being more repeatable and reliable. It also discusses using ganglion cell complex thickness measurements and progression analysis on OCT to detect damage earlier than visual field tests. Additional techniques like electroretinography and visual evoked potentials can detect even earlier changes in the visual system to aid in glaucoma diagnosis and monitoring treatment effectiveness.
NW2010 Macular hole
This document provides an overview of macular holes (MH), including their epidemiology, pathogenesis, classification, diagnosis, natural course, treatment, and outcomes. Some key points:
- MHs are full-thickness defects in the macula that result in central vision loss. The most common cause is idiopathic vitreous traction.
- MHs are classified into 4 stages based on size and the presence of a posterior vitreous detachment. Stage 3 holes over 400 microns rarely close spontaneously.
- Treatment involves pars plana vitrectomy to relieve vitreous traction, with or without internal limiting membrane peeling. An air-gas bubble or silicone oil is used to tampon
Oct angiography topcon leaflet may 2015
OCT-Angiography is a dye-less method, unlike traditional Fluorescein Angiography and ICG. OCT-Angiography is three dimensional, which allows to scroll through depths and layers, showing superficial and deeper capillaries.
NW2010 Epiretinal membrane
This document discusses epiretinal membrane (ERM), a fibrocellular membrane that forms on the inner surface of the retina. It causes varying degrees of macular dysfunction. ERM can be idiopathic or secondary to conditions like retinal detachment repair. Symptoms include vision loss and metamorphopsia. Diagnosis is usually clinical but OCT and FFA can help. Treatment is usually vitrectomy to peel the membrane if it is causing visual symptoms. Outcomes are generally good with most patients improving, but recurrence or worse vision is possible.
Evaluation and Management of Macular Holes
This document summarizes evaluation and management of macular holes. It describes the epidemiology, pathogenesis, classification, diagnosis, treatment and outcomes of macular hole surgery. Key points include: macular holes are more common in females over 70; stage 3 holes have the worst vision; surgery involves vitrectomy to remove traction and seal the hole with gas or oil; post-op vision improves in 90% of cases with closure rates over 90% when internal limiting membrane is peeled. Complications are low but include retinal detachment and reopening in some cases.
Retina VITREO MACULAR Traction
Posterior vitreous detachment (PVD) involves the separation of the vitreous gel from the retina. It occurs normally with aging as the vitreous liquefies through the processes of synchysis and syneresis. Incomplete PVD can result in vitreomacular adhesion (VMA) which may lead to vitreomacular traction (VMT) or macular hole (MH). Left untreated, VMT and MH can cause severe vision loss or blindness. The current standard treatment is vitrectomy surgery, but pharmacologic therapies offer an alternative to observation in early disease.
Macular hole
This document summarizes macular hole formation and treatment. It describes the stages of macular hole development classified by Gass. Vitrectomy surgery involving fluid-gas exchange has been shown to successfully reattach the macula and improve vision in 58-73% of cases. The author reports high success rates for macular hole closure and visual improvement with vitrectomy using various tamponades and adjuncts like internal limiting membrane peeling. Face down positioning after surgery is important for compliance and optimal outcomes.
Oct updateS -AJAY DUDANI
Recent advances in OCT technology were discussed. New features of Cirrus HD-OCT include enhanced imaging capabilities like OCT angiography, improved anterior segment imaging, swept source technology, and enhanced visualization tools. Clinical cases were also presented to demonstrate the utility of these new technologies in evaluating and managing various retinal diseases.
B scan ppt
This B-scan report interprets the structures of the eye that were studied, including the lens, vitreous, retina, choroid, sclera, and optic nerve head. It discusses various conditions that were observed such as retinal detachment, posterior vitreous detachment, closed funnel retinal detachment, choroidal detachment, retinoblastoma, choroidal osteoma, optic nerve head drusen, and cysticercosis. The report provides details on the findings and differences between these various ocular structures and conditions.
Posterior capsular opacification
1) A 75-year-old male presented with gradual decreased vision in both eyes over the past 3 years. He has a history of cataracts surgery in both eyes.
2) Examination found posterior capsular opacification in both eyes, worse in the left eye. The left eye also showed an irregular pupil, RAPD, and a dull fundus reflex.
3) The patient underwent YAG capsulotomy in the left eye. At 1-week follow-up, his vision had improved but was still reduced in the left eye, likely due to underlying retinal pathology. He was advised to continue his current prescription and follow-up as needed.
Full Thickness Macular Hole (FTMH)
Common cause of central visual field loss
It is most common in females
The role of vitreomacular traction is major cause of macular hole
Other causes include high myopia, which leads to macular retinal detachment and blunt trauma
Una nuova variante di cheratoplastica perforante: la PK decagonale con laser ...
This document describes a prospective study that assesses the use of a decagonal (10-sided polygon) trephination pattern for penetrating keratoplasty (PK) assisted by femtosecond laser. Sixteen eyes underwent the procedure. Short-term results showed that the decagonal trephination profile was effective and safe for PK. Visual acuity improved and astigmatism was reduced compared to conventional PK. However, longer follow-up is needed to determine precise advantages of this technique over conventional PK.
Lecture on Clinical Methods; Anterior Segment Proptosis & Ptosis examination...
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Cataract
Cataract is an opacity in the lens. There are different types and stages of cataract development. Extra capsular cataract extraction is the preferred surgery technique as it has fewer complications than intra capsular extraction. Phacoemulsification is now the best technique as it allows for a small incision, use of topical anesthesia, and faster recovery. Accurate biometry measurements and IOL power calculations are important for good visual outcomes after surgery. Post-operative care involves medications and follow-up to monitor for and treat complications such as infection, inflammation, and posterior capsule opacification.
Bandello pharmacological treatment of vitreo macular traction
Bandello pharmacological treatment of vitreo macular tractionThessaloniki International Vitreo-Retinal Summer School
This document summarizes pharmacological treatment of vitreo-macular traction using ocriplasmin. It defines vitreo-macular traction and adhesion and describes the natural history if left untreated. It outlines the development of ocriplasmin from autologous plasmin to a recombinant form, and phase I-III clinical trial results demonstrating its safety and ability to resolve vitreo-macular adhesion in 26.5% of cases compared to 10.1% for placebo. Potential indications include focal vitreo-macular traction, symptomatic vitreo-macular adhesion, and small non-full thickness or full thickness macular holes.Types of vitrectomy ,indication s and complications
The document discusses types of vitrectomy, including pars plana vitrectomy and minimally invasive transconjunctival vitrectomy. It also covers indications for vitrectomy such as macular diseases, complications of anterior segment surgery, diabetic retinal detachment, and complex retinal detachment. Complications of vitrectomy include postoperative cataract, glaucoma, retinal breaks and detachment, vitreous hemorrhage, and endophthalmitis.
INNOVATION IN RETINAL IMAGING: OPPORTUNITIES & CHALLENGES - History of OCT-A
Presentation from OIS@ASRS 2016.
Participant:
David Huang, MD, PhD - Peterson Professor of Ophthalmology and Professor of Biomedical Engineering at OHSU
Powered by:
Healthegy
For more ophthalmology innovation
Visit us at www.ois.net
Sw sn
This document discusses the management of choroidal hemangioma. It describes two types: diffuse choroidal hemangioma, which is associated with neurocutaneous disorders, and circumscribed choroidal hemangioma, which is a benign vascular tumor of the choroid. Treatment options for circumscribed choroidal hemangioma causing vision loss include photodynamic therapy, which has shown success in reducing exudation and retinal detachment in multiple studies summarized here. However, optimal treatment parameters remain debated, with variability in factors like number of spots, spot size, duration, and number of sessions required.
Macular hole
This document summarizes macular hole and epiretinal membrane. It discusses the vitreous, macula, OCT imaging, pathogenesis and stages of macular hole. It covers risk factors, signs, differential diagnosis and treatment of macular hole including vitrectomy. It also discusses prevalence, risk factors, pathogenesis and components of epiretinal membrane formation.
Keratoplasty , Dr M SAQUIB
1. Keratoplasty, or corneal transplantation, involves replacing part or all of a damaged cornea with donor corneal tissue.
2. There are several types of keratoplasty procedures including penetrating keratoplasty (full thickness), lamellar keratoplasty (partial thickness), DSAEK, and DMEK.
3. Keratoplasty is indicated for conditions such as corneal opacity, dystrophy, infection, trauma, ectasia, and refractive errors. Careful donor preparation, surgical technique, and postoperative management are required for successful outcomes. Complications can include rejection, infection, and recurrence of the underlying condition.
Epiretinal membrane
An epiretinal membrane is an avascular fibrocellular membrane that grows on the inner surface of the retina, causing macular dysfunction. It consists of various cell types and collagen. Symptoms include blurry vision and metamorphopsia. Observation is usually sufficient for mild cases, but surgery is recommended for significant vision loss or distortion. Peeling the membrane improves vision in most cases, though cataracts are a common complication. Prognosis is better when pre-op vision is good and the duration of symptoms is short.
Egs guidelines english
This document provides guidelines for the diagnosis and management of glaucoma put forth by the European Glaucoma Society. It begins with an introduction explaining the purpose and methodology of the guidelines. The guidelines are intended to support general ophthalmologists and use a grading system to indicate the strength of recommendations and quality of evidence. The remainder of the document contains 5 chapters that cover terminology, classification, patient examination techniques, treatment principles and options, and specific treatment guidelines for different types of glaucoma. The goal of glaucoma treatment outlined is to maintain a patient's vision and quality of life while considering treatment costs. The guidelines are meant to be recommendations rather than strict protocols and must be tailored to individual patients.
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Oct angiography topcon leaflet may 2015
OCT-Angiography is a dye-less method, unlike traditional Fluorescein Angiography and ICG. OCT-Angiography is three dimensional, which allows to scroll through depths and layers, showing superficial and deeper capillaries.
NW2010 Epiretinal membrane
This document discusses epiretinal membrane (ERM), a fibrocellular membrane that forms on the inner surface of the retina. It causes varying degrees of macular dysfunction. ERM can be idiopathic or secondary to conditions like retinal detachment repair. Symptoms include vision loss and metamorphopsia. Diagnosis is usually clinical but OCT and FFA can help. Treatment is usually vitrectomy to peel the membrane if it is causing visual symptoms. Outcomes are generally good with most patients improving, but recurrence or worse vision is possible.
Evaluation and Management of Macular Holes
This document summarizes evaluation and management of macular holes. It describes the epidemiology, pathogenesis, classification, diagnosis, treatment and outcomes of macular hole surgery. Key points include: macular holes are more common in females over 70; stage 3 holes have the worst vision; surgery involves vitrectomy to remove traction and seal the hole with gas or oil; post-op vision improves in 90% of cases with closure rates over 90% when internal limiting membrane is peeled. Complications are low but include retinal detachment and reopening in some cases.
Retina VITREO MACULAR Traction
Posterior vitreous detachment (PVD) involves the separation of the vitreous gel from the retina. It occurs normally with aging as the vitreous liquefies through the processes of synchysis and syneresis. Incomplete PVD can result in vitreomacular adhesion (VMA) which may lead to vitreomacular traction (VMT) or macular hole (MH). Left untreated, VMT and MH can cause severe vision loss or blindness. The current standard treatment is vitrectomy surgery, but pharmacologic therapies offer an alternative to observation in early disease.
Macular hole
This document summarizes macular hole formation and treatment. It describes the stages of macular hole development classified by Gass. Vitrectomy surgery involving fluid-gas exchange has been shown to successfully reattach the macula and improve vision in 58-73% of cases. The author reports high success rates for macular hole closure and visual improvement with vitrectomy using various tamponades and adjuncts like internal limiting membrane peeling. Face down positioning after surgery is important for compliance and optimal outcomes.
Oct updateS -AJAY DUDANI
Recent advances in OCT technology were discussed. New features of Cirrus HD-OCT include enhanced imaging capabilities like OCT angiography, improved anterior segment imaging, swept source technology, and enhanced visualization tools. Clinical cases were also presented to demonstrate the utility of these new technologies in evaluating and managing various retinal diseases.
B scan ppt
This B-scan report interprets the structures of the eye that were studied, including the lens, vitreous, retina, choroid, sclera, and optic nerve head. It discusses various conditions that were observed such as retinal detachment, posterior vitreous detachment, closed funnel retinal detachment, choroidal detachment, retinoblastoma, choroidal osteoma, optic nerve head drusen, and cysticercosis. The report provides details on the findings and differences between these various ocular structures and conditions.
Posterior capsular opacification
1) A 75-year-old male presented with gradual decreased vision in both eyes over the past 3 years. He has a history of cataracts surgery in both eyes.
2) Examination found posterior capsular opacification in both eyes, worse in the left eye. The left eye also showed an irregular pupil, RAPD, and a dull fundus reflex.
3) The patient underwent YAG capsulotomy in the left eye. At 1-week follow-up, his vision had improved but was still reduced in the left eye, likely due to underlying retinal pathology. He was advised to continue his current prescription and follow-up as needed.
Full Thickness Macular Hole (FTMH)
Common cause of central visual field loss
It is most common in females
The role of vitreomacular traction is major cause of macular hole
Other causes include high myopia, which leads to macular retinal detachment and blunt trauma
Una nuova variante di cheratoplastica perforante: la PK decagonale con laser ...
This document describes a prospective study that assesses the use of a decagonal (10-sided polygon) trephination pattern for penetrating keratoplasty (PK) assisted by femtosecond laser. Sixteen eyes underwent the procedure. Short-term results showed that the decagonal trephination profile was effective and safe for PK. Visual acuity improved and astigmatism was reduced compared to conventional PK. However, longer follow-up is needed to determine precise advantages of this technique over conventional PK.
Lecture on Clinical Methods; Anterior Segment Proptosis & Ptosis examination...
Lecture on Clinical Methods; Anterior Segment Proptosis & Ptosis examination For 4th Year MBBS Undergraduate Students By Prof. Dr. Hussain Ahmad Khaqan
Cataract
Cataract is an opacity in the lens. There are different types and stages of cataract development. Extra capsular cataract extraction is the preferred surgery technique as it has fewer complications than intra capsular extraction. Phacoemulsification is now the best technique as it allows for a small incision, use of topical anesthesia, and faster recovery. Accurate biometry measurements and IOL power calculations are important for good visual outcomes after surgery. Post-operative care involves medications and follow-up to monitor for and treat complications such as infection, inflammation, and posterior capsule opacification.
Bandello pharmacological treatment of vitreo macular traction
Bandello pharmacological treatment of vitreo macular tractionThessaloniki International Vitreo-Retinal Summer School
This document summarizes pharmacological treatment of vitreo-macular traction using ocriplasmin. It defines vitreo-macular traction and adhesion and describes the natural history if left untreated. It outlines the development of ocriplasmin from autologous plasmin to a recombinant form, and phase I-III clinical trial results demonstrating its safety and ability to resolve vitreo-macular adhesion in 26.5% of cases compared to 10.1% for placebo. Potential indications include focal vitreo-macular traction, symptomatic vitreo-macular adhesion, and small non-full thickness or full thickness macular holes.Types of vitrectomy ,indication s and complications
The document discusses types of vitrectomy, including pars plana vitrectomy and minimally invasive transconjunctival vitrectomy. It also covers indications for vitrectomy such as macular diseases, complications of anterior segment surgery, diabetic retinal detachment, and complex retinal detachment. Complications of vitrectomy include postoperative cataract, glaucoma, retinal breaks and detachment, vitreous hemorrhage, and endophthalmitis.
INNOVATION IN RETINAL IMAGING: OPPORTUNITIES & CHALLENGES - History of OCT-A
Presentation from OIS@ASRS 2016.
Participant:
David Huang, MD, PhD - Peterson Professor of Ophthalmology and Professor of Biomedical Engineering at OHSU
Powered by:
Healthegy
For more ophthalmology innovation
Visit us at www.ois.net
Sw sn
This document discusses the management of choroidal hemangioma. It describes two types: diffuse choroidal hemangioma, which is associated with neurocutaneous disorders, and circumscribed choroidal hemangioma, which is a benign vascular tumor of the choroid. Treatment options for circumscribed choroidal hemangioma causing vision loss include photodynamic therapy, which has shown success in reducing exudation and retinal detachment in multiple studies summarized here. However, optimal treatment parameters remain debated, with variability in factors like number of spots, spot size, duration, and number of sessions required.
Macular hole
This document summarizes macular hole and epiretinal membrane. It discusses the vitreous, macula, OCT imaging, pathogenesis and stages of macular hole. It covers risk factors, signs, differential diagnosis and treatment of macular hole including vitrectomy. It also discusses prevalence, risk factors, pathogenesis and components of epiretinal membrane formation.
Keratoplasty , Dr M SAQUIB
1. Keratoplasty, or corneal transplantation, involves replacing part or all of a damaged cornea with donor corneal tissue.
2. There are several types of keratoplasty procedures including penetrating keratoplasty (full thickness), lamellar keratoplasty (partial thickness), DSAEK, and DMEK.
3. Keratoplasty is indicated for conditions such as corneal opacity, dystrophy, infection, trauma, ectasia, and refractive errors. Careful donor preparation, surgical technique, and postoperative management are required for successful outcomes. Complications can include rejection, infection, and recurrence of the underlying condition.
Epiretinal membrane
An epiretinal membrane is an avascular fibrocellular membrane that grows on the inner surface of the retina, causing macular dysfunction. It consists of various cell types and collagen. Symptoms include blurry vision and metamorphopsia. Observation is usually sufficient for mild cases, but surgery is recommended for significant vision loss or distortion. Peeling the membrane improves vision in most cases, though cataracts are a common complication. Prognosis is better when pre-op vision is good and the duration of symptoms is short.
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Types of vitrectomy ,indication s and complications
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- 1. decision algorithms in clinical ophthalmology PROLIFERATIVE DIABETIC RETINOPATHY CATARACT COMPLETE LASER PHOTOCOAGULATION INCOMPLETE LASER PHOTOCOAGULATION REGRESSION OF NEW VESSELS LACK OF REGRESSION OF NEW VESSELS PARS PLANA VITRECTOMY CATARACT EXTRACTION LASER ENDOPHOTOCOAGULATION Cosimo Loré, Andrea Perinti www.scienzemedicolegali.it