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Dr Hoyos’ Step by Step Basic Vitrectomy
Jairo E Hoyos, José J Martínez-Toldos
CHAPTER 1:
Surgical Anatomy
EXTRAOCULAR MUSCLES
GLOBE ANATOMY
VITREOUS BODY
CILIARY BODY
BASE OF THE VITREOUS
SCLEROTOMY
CHAPTER 2:
Presurgery Examination
MEDICAL HISTORY
VISUAL ACUITY
COLOR PERCEPTION
VASCULAR ENTOPTIC TEST
SLIT-LAMP MICROSCOPY
TONOMETRY
FUNDUS EXAMINATION
ULTRASONOGRAPHY
OPTICAL COHERENCE TOMOGRAPHY (OCT)
Macular Hole
Vitreomacular Traction Syndrome
Epiretinal Membrane
Macular Edema
CHAPTER 3:
Anesthesia
GENERAL ANESTHESIA
Precautions using General Anesthesia in Vitreoretinal Surgery
LOCAL ANESTHESIA
Retrobulbar Block
Peribulbar Block
Sub-Tenon Anesthesia
Our Technique: Transconjunctival Retrobulbar Anesthesia
CHAPTER 4:
Instrumentation
OPERATING ROOM
Ophthalmologic Surgery Table
Instrument Column
Image Recorder
Operating Microscope
VISUALIZATION SYSTEMS
Wide-field Systems
Use of the EIBOS System
Other Visualization Systems
ENDOILLUMINATION
External Systems
Internal Systems
INFUSION PRESSURE
Hydrostatic Pressure
Infusion Pump or Gas-forced Infusion
Ocular Hypotension
Ocular Hypertension
INFUSION DEVICES
SUCTION AND CUTTER SYSTEMS
Active Aspiration
Flow control using the Accurus vitreotome:
Passive Aspiration
Vitrectomy Probes
DIATHERMY
RETINOPEXY
Laser Endophotocoagulation
Argon Laser
810 nm Infrared Diode Laser
532 nm Green Diode Laser
PHACOEMULSIFICATION
ULTRASONIC FRAGMENTATION
FORCEPS AND SCISSORS
VITREOUS SUBSTITUTES: MANIPULATORS
Hyaluronic Acid
Perfluorocarbon Liquids
VITREOUS SUBSTITUTES: TAMPONADES
Intraocular Gases
Silicone Oil
Silicone Solvent
Heavy Silicone Oil
CHAPTER 5:
Basic Vitrectomy
INTRODUCTION
VISUALIZATION SYSTEMS
CONJUNCTIVAL INCISIONS
SCLEROTOMY
PUPIL MANAGEMENT
LENSECTOMY
Surgical Technique
PHACOEMULSIFICATION
Prerequisites
Surgical Technique
Special Cases
BASIC VITREOUS REMOVAL
Removing the Posterior Hyaloid
VACUUM TECHNIQUES
Active Aspiration
Passive Aspiration
DISSECTING MEMBRANES
Membrane Segmentation
Membrane Delamination
STAINING MEMBRANES
Indocyanine Green
Trypan Blue
Triamcinolone Acetonide
USE OF PERFLUOROCARBON LIQUIDS
Injection of PFCL Under Physiological Saline
PFCL Removal and Air Introduction
PFCL Removal Without Air Introduction
Direct Exchange for Silicone Oil
Potential Problems during the Use of Perfluorocarbons
Uses of PFCL
FLUID-AIR-GAS EXCHANGE DURING VITRECTOMY
SILICONE OIL IN VITREOUS-RETINAL SURGERY
Indications for the Use of Silicone Oil
Removal of Silicone Oil
CLOSURE AFTER THE SURGICAL PROCEDURE
CHAPTER 6:
Minimally Invasive Ophthalmic Surgery: 23- and 25-Gauge Vitrectomy
INTRODUCTION
INSTRUMENTATION
TROCAR INSERTION SYSTEM (ACCURUS)
INFUSION CANNULA (ACCURUS)
ENDOILLUMINATION SYSTEM
25-GAUGE FORCEPS AND SCISSORS
23-GAUGE VITRECTOMY
25-GAUGE SURGERY TECHNIQUE
CHAPTER 7:
Vitrectomy for Anterior Segment Surgery Complications
INTRODUCTION
OCULAR PERFORATION DURING RETROBULBAR ANESTHESIA
Ocular Perforation
Treatment
RETROBULBAR HEMORRHAGE
ANTERIOR VITRECTOMY
Vitrectomy following Vitreous Loss
RETAINED LENS FRAGMENTS
Surgical Indications
Performing Vitreous Surgery at the Time of Lens Luxation
Surgical Technique
Soft Remnants at the Anterior and Posterior Poles
Medium Hardness Remains at the Posterior Pole
Hard Crystalline Lens Remains
Remains of Any Grade with Retinal Detachment
Hard Lens Remnants with Retinal Detachment
IOL DISLOCATION
Surgical Technique
Use of Perfluorocarbon Liquid
Lifting with Forceps
Implanting an Aphakic Artisan Lens
ENDOPHTHALMITIS
Classifying Postsurgery Endophthalmitis
Etiology
Treatment
Dose of Intravitreous Antibiotics
Subconjunctival
Topical
General
Infusion Drip
Vitrectomy
Anterior Approach
Posterior Approach
CHAPTER 8:
Vitrectomy in Diabetic Retinopathy
INTRODUCTION
VITRECTOMY
DIABETIC DENSE PREMACULAR HEMORRHAGE
HEMOLYTIC GLAUCOMA
RECURRENT HEMORRHAGE
ANTERIOR HYALOID FIBROVASCULAR PROLIFERATION
SCLERAL INDENTATION
CHAPTER 9:
Macular Surgery
INTRODUCTION
EPIRETINAL MEMBRANE
Vitrectomy
VITREOMACULAR TRACTION SYNDROME
MACULAR HOLE
Treatment
MACULAR EDEMA IN DIABETIC RETINOPATHY
SUBMACULAR HEMORRHAGE
CYSTOID MACULAR EDEMA IN APHAKIA AND PSEUDOPHAKIA
Pathogenesis
Clinical Evolution
Treatment
Vitrectomy
MACULAR EDEMA IN RETINALVEIN OCCLUSION
CHAPTER 10:
Vitrectomy for Retinal Detachment With and Without Proliferative Vitreoretinopathy
INTRODUCTION
COMBINED VITRECTOMY AND SCLERAL BUCKLING
Scleral Buckling Technique
Preparation of the Surgical Field
Accurate Placement of the Buckle on the Sclera
Encircling Exoplants
Scleral Suture Technique
Primary Vitrectomy
Basic Operative Steps in Primary Vitrectomy
Removal of Vitreous Opacities Preventing Adequate Visualization
Removal of Perpendicular Traction
Removal of Posterior Cortical Vitreous (Tangential Traction)
Membrane Surgery Approach
Flattening the Retina With Perfluorocarbon (PFC)/ Fluid-Air Exchange/PFC–Air Exchange
Tamponade With Gas or Silicone Oil
Creating Chorioretinal Adhesion With Endolaser
Intraocular Tamponade
Vitrectomy for Retinal Detachment With Proliferative Vitreoretinopathy
Risk Factors for the Development of Proliferative Vitreoretinopathy
Diagnosis of Proliferative Vitreoretinopathy
Classification of Proliferative Vitreoretinopathy
Surgery for Proliferative Vitreoretinopathy
Vitrectomy for Proliferative Vitreoretinopathy
Removal of Posterior Epiretinal Proliferation
Removal of Anterior Epiretinal Proliferation
Removal of Subretinal Proliferation
Relaxing Retinotomies and Retinectomies
Creating a Chorioretinal Adhesion
Intraocular Tamponade
Removal of Silicone Oil
Reoperations for Recurrent RD from PVR
Adjunctive Treatment in Proliferative Vitreoretinopathy
Giant Retinal Tears
Postoperative Complications
SUMMARY
CHAPTER 11:
Posterior Vitrectomy Complications
INTRODUCTION
INTRAOPERATIVE COMPLICATIONS
Sclerotomy Complications
Placement of the Infusion Cannula
Vitreous or Retinal Incarceration
Hemorrhage
Retinal Tears
Visualization Problems
Corneal Complications
Myosis
Cataract
IOL Complications
Hemorrhage
Retinal Tears
Anterior Retinal Iatrogenic Tears
Posterior Retinal Iatrogenic Tears
Retinopexy Complications
Endolaser
Cryotherapy
POSTOPERATIVE COMPLICATIONS
Corneal Complications
Ocular Hypertention and Glaucoma
Vitreous Hemorrhage
Early (first month)
Late (after the first month)
Retinal Detachment
RD Exudative
RD due to Posterior Break
RD due to Anterior Break
Proliferative Vitreoretinopathy (PVR)
Clinical Factors
Surgical Factors
Intraocular Inflammation and Fibrinoid Reaction
Tamponade and Manipulator Agents Complications
Intraocular Gas
Silicone Oil
Perfluorocarbon Liquid (PFCL)
Endophthalmitis
Cataract
TO PREVENT VITRORETINAL SURGERY COMPLICATIONS
INDEX
TOC
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