Jaypee Brothers
In Current Chapter
In All Chapters
X
Clear
X
GO
Normal
Sepia
Dark
Default Style
Font Style 1
Font Style 2
Font Style 3
Less
Normal
More
Principles and Practice of Vitreoretinal Surgery
Narendran V, Abhishek R Kothari, Steve Charles, Ingrid Kreissig
SECTION 1: BASICS
CHAPTER 1:
Vitreous and Vitreoretinal Interface
1. INTRODUCTION
2. DEVELOPMENT
2.1. Development of the Vitreous Body
2.2. Persistence of Fetal Vasculature
3. ANATOMY
3.1. Gross Anatomy
3.2. Microscopic Structure
3.2.1. Cortex
3.2.2. Central Vitreous
3.3. Vitreous Attachments
3.3.1. Optic Nerve Head
3.3.2. Macula
3.3.3. Along Major Retinal Vessels
3.3.4. Vitreous Base
3.4. The Internal Limiting Membrane or Lamina
4. BIOCHEMISTRY
4.1. Composition
4.1.1. Collagens
4.1.2. Hyaluronic Acid (HA)
4.2. Age-related Changes in the Vitreous
5. POSTERIOR VITREOUS DETACHMENT
5.1. Significance of Posterior Vitreous Detachment
6. VITREOSCHISIS
7. ANOMALOUS POSTERIOR VITREOUS DETACHMENT
8. COMPLICATIONS FROM CHANGES IN THE VITREOUS
8.1. Macular Complications
8.2. Retinal Breaks and Detachment
8.3. Retinopathy of Prematurity
9. PHARMACOLOGIC VITREOLYSIS
9.1. Plasmin and Microplasmin
9.2. Dipase
9.3. Hyaluronidase
9.4. Chondroitinase
10. CONCLUSION
CHAPTER 2:
Role of OCT in Decision Making for Vitreoretinal Surgery
1. INTRODUCTION
2. FULL THICKNESS MACULAR HOLES
2.1. Stages
2.2. Monitoring and Prognostication
3. MYOPIC MACULAR PATHOLOGY
4. LAMELLAR MACULAR HOLE
5. EPIRETINAL MEMBRANE
6. MACULAR PSEUDOHOLES
7. VITREOMACULAR TRACTION SYNDROME
8. TRACTIONAL RETINAL DETACHMENT
9. UNEXPLAINED VISUAL DISTURBANCES
10. CONCLUSION
CHAPTER 3:
Preoperative Considerations
1. GOAL OF SURGERY AND ROLE OF PREOPERATIVE WORKUP
2. GENERAL CONSIDERATIONS
3. SAFETY FIRST-SYSTEMIC EVALUATION OF THE VITREORETINAL PATIENT
4. LOCAL EXAMINATION
5. INSTRUCTIONS TO PATIENTS AND WARD STAFF
6. IMMEDIATE POSTOPERATIVE MANAGEMENT
CHAPTER 4:
Anesthesia for Vitreoretinal Surgery
1. INTRODUCTION
2. CHOICE OF ANESTHETIC TECHNIQUE
2.1. Prerequisites for VR Surgery Planned Under Regional Anesthesia
2.2. Prerequisites for VR Surgery Planned Under General Anesthesia
3. PREOPERATIVE ASSESSMENT AND PREPARATION
3.1. History and Examination
3.2. Investigations
3.3. Preparation of the Patients for Surgery
3.4. Ischemic Heart Disease Patients
3.5. Hypertension
3.6. Chronic Obstructive Pulmonary Disease
3.7. Diabetes Mellitus
3.8. Patients on Antiplatelet and Anticoagulants Medications
4. ORBITAL REGIONAL ANESTHESIA
4.1. Preparation of the Patient for Regional Blocks
4.2. Intraconal (Retrobulbar) Block
4.3. Extraconal (Peribulbar) Block
4.4. Medial Peribulbar Block
4.5. Sub-Tenon's Block
4.6. Choice of Local Anesthetic Agents
4.7. Intraoperative Considerations
4.7.1. Special Frame for VR Surgery
4.7.2. Posture and Positioning of Patients during Surgery
4.7.3. Monitoring
4.7.4. Oculocardiac Reflex
4.7.5. Sedation during VR Surgery
4.7.6. Retinal Circulation and Hypotension
5. GENERAL ANESTHESIA
5.1. Premedication
5.2. Induction
5.3. Airway Management and Maintenance of Anesthesia
5.4. Extubation
5.5. Special Considerations for General Anesthesia
5.5.1. Intravitreal Gases and Nitrous Oxide
5.5.2. VR Surgery Combined with Anterior Surgery (Perforating Keratoplasty or “Open Sky Situations”)
5.5.3. VR Surgery Combined with Glaucoma Surgery
5.5.4. Combined General Anesthesia and Regional Anesthesia for VR Surgery
6. POSTOPERATIVE CARE
6.1. Pain Relief
6.1.1. Postoperative Nausea and Vomiting
CHAPTER 5:
Vitreoretinal Surgical Suite
1. INTRODUCTION
2. BASIC DESIGN CONSIDERATIONS
2.1. Location
2.2. Different Zones of the Operating Room Complex
2.3. Anesthesia Room/Holding Area
2.4. Ambulatory Unit
2.5. Postanesthesia Care or Recovery Unit
2.6. Operating Room
2.6.1. Size
2.6.2. Construction
2.6.3. Atmosphere
2.6.4. Lighting
2.6.5. Communication Systems
2.7. Substerile Room
3. BASIC OPERATIONAL CONSIDERATIONS
3.1. Safety
3.2. Efficiency
3.3. Operating Room Arrangement
3.4. Nurse In-Charge/Operating Room Manager
3.5. Training and Monitoring
4. CONCLUSION
CHAPTER 6:
Tools of the Trade
1. INTRODUCTION
2. SURGICAL DRAPES
3. GENERAL EXTRAOCULAR INSTRUMENTS
3.1. Speculum
3.2. Forceps
3.3. Needle Holders
3.4. Scissors
3.5. Retractors
3.6. Muscle Hooks
3.7. Scleral Depressors
3.8. Scleral Dissectors
3.9. Calipers and Markers
3.10. Fixation Plates
3.11. Suture Materials
3.12. Buckle Materials
4. VITRECTOMY-RELATED INSTRUMENTS
4.1. Microvitreoretinal Blade
4.2. Trocar–Cannula Systems
4.3. Infusion Cannula
4.4. Illumination
4.4.1. Endoillumination
4.4.2. Exoillumination
4.4.3. Light Probe/Pipe
4.4.4. Safety Issues
4.5. Vitrectomy Probes or Cutters
4.5.1. Cutter Mechanics
4.5.2. Cutter Dynamics
4.6. Intraocular Instruments
4.6.1. Intraocular Forceps Tips (Figs 6.5A to E)
4.6.2. Scissors (Figs 6.5F to H)
4.6.3. Picks and Spatulas (Fig. 6.5I)
4.6.4. Extrusion and Back Flush Instruments
4.6.5. Miscellaneous
4.7. Cryotherapy
4.7.1. Principle
4.7.2. Mechanism of Action
4.7.3. Clinical Application
4.8. Diathermy and Cautery
4.9. Viscous Fluid Systems
5. CONCLUSION
CHAPTER 7:
Vitreoretinal Surgery Systems
1. HISTORY
2. THE OCULAR CONNECTION MACHINE AND THE ACCURUS VITREORETINAL SURGERY SYSTEM
3. THE CONSTELLATION VISION SYSTEM
4. SUMMARY
CHAPTER 8:
Understanding Fluidics and Machine Parameters— Optimizing Performance
1. HISTORY
2. FLUID DYNAMICS OF VITRECTOMY
2.1. Intraocular Pressure (IOP) Control—Key Concepts
2.1.1. Infusion Systems
2.2. Aspiration and Vacuum
2.2.1. Fluid Pumps
2.3. Vitrectomy Probes—Dynamics
2.3.1. Interactions of Cutter Gauge, Cutting Speed, Vacuum and Flow Rate
2.4. Special Aspects of Fluidics with MIVS
2.4.1. High Cutting Frequency
2.4.2. Port-based Flow Limitation
2.4.3. Aspiration Flow Rate Control
2.4.4. Fluidic Aspects of PVD Induction
3. FRAGMENTATION
4. EXTRUSION
5. REFLUX
6. VISCOUS FLUID INJECTION AND EXTRACTION
7. CONCLUSION
CHAPTER 9:
Irrigating Fluids for Vitrectomy
1. INTRODUCTION
2. TISSUE CONCERNS FROM INTRAOCULAR FLUIDS DURING VITRECTOMY
2.1. Corneal Endothelium
2.2. Lens Epithelium
2.3. Retina
3. COMPONENTS OF INFUSION FLUIDS
3.1. Electrolytes
3.2. pH and Buffers
3.3. Glucose
3.4. Other Constituents
3.5. Osmolality
4. COMMERCIAL IRRIGATING FLUIDS
5. CONCLUSION
CHAPTER 10:
Viewing Systems for Vitrectomy
1. INTRODUCTION
2. CONVENTIONAL VIEWING SYSTEMS
2.1. Hand-held Contact Lens
2.2. Hands Free Contact Lens
3. WIDE ANGLE VIEWING SYSTEMS
3.1. Noncontact Systems
3.2. Contact Systems
4. RECENT ADVANCES
5. SUMMARY
CHAPTER 11:
Intraoperative Adjuncts
1. INTRODUCTION
2. EARLY DEVELOPMENTS
3. INDOCYANINE GREEN
4. INFRACYANINE GREEN
5. TRYPAN BLUE
6. BRILLIANT BLUE G
7. TRIAMCINOLONE ACETONIDE (TA)
8. PATENT BLUE
9. CONCLUSION
1. INTRODUCTION
2. PHYSICAL PROPERTIES AND THEIR IMPLICATIONS FOR SURGICAL USE
3. USE IN VITREORETINAL SURGERY
3.1. Method of Injecting Perfluorocarbon Liquids
3.2. Applications
3.2.1. Rhegmatogenous Retinal Detachment
3.2.2. Complex Retinal Detachments
3.2.3. Proliferative Diabetic Retinopathy
3.2.4. Macular Hole with Retinal Detachment
3.2.5. Giant Retinal Tears
3.2.6. Exudative Retinal Detachments
3.2.7. Dislocated Lens Matter and Intraocular Lens
3.2.8. Other Applications
3.3. Complications
4. CONCLUSION
SECTION 2: VITREOUS SURGERY BASICS
CHAPTER 12:
20-Gauge Vitrectomy
1. INTRODUCTION
2. EQUIPMENT FOR PARS PLANA VITRECTOMY
2.1. Operating Microscope
2.2. Instrumentation
3. BASIC VITRECTOMY TECHNIQUE
3.1. Preliminaries
3.2. Sclerotomies
3.3. Vitreous Removal
3.4. Special Techniques Using 20-Gauge Instruments
3.4.1. Lensectomy16
3.4.2. Membrane Removal
3.4.3. Other Procedures
3.5. Closure
4. COMPLICATIONS
5. CONCLUSION
CHAPTER 13:
23-Gauge Vitrectomy
1. INTRODUCTION
2. INDICATIONS
3. WOUND CONSTRUCTION TECHNIQUES AND MICROCANNULA PLACEMENT
4. INSTRUMENTATION
5. DIFFERENCES BETWEEN 23-GAUGE AND 20-GAUGE/25-GAUGE
6. SURGERY
7. MICROCANNULA REMOVAL AND WOUND CLOSURE
8. COMPLICATIONS OF 23-GAUGE VITRECTOMY
9. CONCLUSION
CHAPTER 14:
25-Gauge Sutureless Transconjunctival Vitrectomy
1. INTRODUCTION
2. CASE SELECTION
3. TROCAR CANNULA SYSTEM AND INCISIONS
4. FLUIDICS
5. TOOL ISSUES
5.1. Tool Flexion
5.2. Combined 25-and 20-Gauge Vitrectomy
5.3. Visualization
6. WOUND LEAK ISSUES
7. POSTOPERATIVE ENDOPHTHALMITIS AND RETINAL DETACHMENTS
8. CANNULA WITHDRAWAL AND WOUND CLOSURE
9. SUMMARY
CHAPTER 15:
Interfacial Tension Agents, Exchanges and Subretinal Fluid Drainage
1. SURFACE TENSION MANAGEMENT AND EXCHANGES
2. PHYSICAL CONSIDERATION
3. INTERFACIAL TENSION AGENTS
4. NOMENCLATURE
5. DRAINAGE OF SUBRETINAL FLUID
5.1. History
5.2. Procedure
5.3. Drainage Retinotomy
6. INTRAOCULAR LENS (IOLs) FOGGING DURING FLUID-AIR EXCHANGE
7. AIR-GAS EXCHANGE
8. LIQUID PERFLUOROCARBON
8.1. Liquid Perfluorocarbon in Subretinal Fluid Drainage
8.2. Medium-term Perfluorooctane
8.3. Giant Retinal Breaks
9. AIR-SILICONE EXCHANGE
10. SILICONE OIL REMOVAL
11. SILICONE REOPERATIONS
CHAPTER 16:
Hemostasis during Vitreoretinal Surgery
1. INTRODUCTION
2. BASICS
2.1. Sources
2.2. Hemostasis
3. PREOPERATIVE CONSIDERATIONS
3.1. Diet and Herbal Supplements
3.2. Pharmacological Agents
3.3. Systemic Ailments
3.4. Ocular Inflammation
3.5. Laser Photocoagulation
3.6. Vascular Endothelial Growth Factor Blockade
4. INTRAOPERATIVE FACTORS
4.1. Choice of Anesthesia
4.2. Irrigating Solution
4.3. Plasma Knife
5. INTRAOPERATIVE HEMOSTASIS
5.1. Elevation of Intraocular Pressure
5.2. Direct Compression of Severed Vessel
5.3. Endodiathermy
5.4. Endophotocoagulation
5.5. Fluid–Air Exchange
5.6. Viscoelastic Agents
5.7. Perfluorocarbon Liquids
5.8. Silicone Oil
5.9. Pharmacomodulation with Fibrinogenic Agents
5.10. Heparin
5.11. Miscellaneous
6. POSTOPERATIVE VITREOUS HEMORRHAGE (VITREOUS CAVITY HEMORRHAGE)
7. SUPRACHOROIDAL HEMORRHAGE
8. SUMMARY
CHAPTER 17:
Endolaser
1. INTRODUCTION
2. LASER TISSUE INTERACTIONS
3. LASER IN SURGERY
4. ENDOLASER PROBES
5. LASER FILTERS
6. INTRAOPERATIVE USE
7. INDICATIONS
7.1. Retinal Holes, Retinal Tears, Retinectomies and Accidental Retinotomies
7.2. Panretinal Laser Photocoagulation
7.3. Hemostasis
7.4. Other Applications
8. COMPLICATIONS
9. CONCLUSION
CHAPTER 18:
Intraocular Gases
1. HISTORICAL BACKGROUND
2. PHYSICOCHEMICAL PROPERTIES OF GASES
2.1. Chemical Properties
2.2. Physical Properties
2.2.1. Surface Tension
2.2.2. Buoyancy
2.3. Arc of Tamponade
3. KINETICS OF INTRAOCULAR GASES
3.1. Bubble Expansion
3.1.1. Effect of Nitrous Oxide on Gas Kinetics
3.2. Nitrogen Equilibration
3.3. Bubble Dissolution
3.4. Change with Atmospheric Pressure
4. CLINICAL USE
4.1. Choice of Gas
4.2. Preparation of Gas
4.3. Technique of Gas Injection
4.3.1. Fluid–Air Exchange and Air–Gas Exchange During Vitrectomy
4.3.2. Gas Injection in Non-vitrectomized Eyes in the OR
4.3.3. Outpatient Injection of Expansile Gas in Non-vitrectomized Eyes
4.3.4. Outpatient Fluid Gas Exchange in Vitrectomized Eyes
5. POSTOPERATIVE POSITIONING AND CARE
6. COMPLICATIONS
6.1. High Intraocular Pressure
6.2. Inadequate Gas Bubble Size
6.3. Subretinal Gas Bubble
6.4. Corneal Endothelial Cell Damage
6.5. Cataract
6.6. Visual Field Loss
7. CONCLUSION
CHAPTER 19:
Long-term Intraocular Tamponade with Silicone Oil
1. INTRODUCTION
2. PROPERTIES OF SILICONE OIL
2.1. Chemical Properties
2.2. Physical Properties
2.2.1. Specific Gravity
2.2.2. Buoyancy
2.2.3. Interfacial Tension or Surface Tension
2.2.4. Viscosity
3. CLINICAL INDICATIONS
3.1. General
3.2. Retinal Detachment with Severe Proliferative Vitreoretinopathy
3.2.1. Silicone Study Report 119
3.2.2. Silicone Study Report 220
3.2.3. Silicone Study Report 321
3.2.4. Silicone Study Report 422
3.3. Giant Retinal Tear
3.4. Severe Proliferative Diabetic Retinopathy
3.5. Macular Hole
3.6. Pathologic Myopia
3.7. Cytomegalovirus Retinitis
3.8. Complicated Pediatric Retinal Detachment
3.9. Trauma
4. SURGICAL TECHNIQUES IN THE USE OF SILICONE OIL
4.1. Infusion of Silicone Oil
4.1.1. Air-Silicone Oil Exchange
4.1.2. Perflurocarbon Liquid-Silicone Oil Exchange
4.1.3. Fluid-Silicone Exchange
4.2. Removal of Silicone Oil
4.2.1. Procedure
4.2.2. Implications of Silicone Oil Removal
5. COMPLICATIONS OF SILICONE OIL
5.1. Glaucoma
5.2. Cataract
5.2.1. Axial Length Calculations in a Phakic Eye with Silicone Oil In Situ
5.3. Keratopathy
5.4. Recurrent Retinal Detachment
5.5. Hypotony
5.6. Silicone Oil Emulsification
5.7. Others
6. FUTURE DEVELOPMENTS
CHAPTER 20:
Vitreous Surgery— Complications and their Management
1. INTRODUCTION
2. INTRAOPERATIVE COMPLICATIONS
2.1. Retinal Breaks
2.2. Lens Opacity
2.3. Choroidal Hemorrhage
3. POSTOPERATIVE COMPLICATIONS
3.1. Increased Intraocular Pressure
3.2. Endophthalmitis
3.3. Hypotony
3.4. Intraocular Bleeding
3.5. Retinal Detachment
3.6. Intraocular Lens Dislocation
3.7. Macular Complications
4. CONCLUSION
SECTION 3: SPECIAL CONSIDERATIONS
CHAPTER 21:
Anterior Segment Concerns in Vitreoretinal Surgery
1. INTRODUCTION
2. CORNEAL ISSUES
3. PUPIL MANAGEMENT
4. MANAGING THE LENS
5. CONCLUSION
CHAPTER 22:
Temporary Keratoprosthesis: Retinal Surgery in the Presence of an Opaque Cornea
1. INTRODUCTION
2. THE TEMPORARY KERATOPROSTHESIS
3. SURGICAL TECHNIQUE
4. OUTCOMES
5. SPECIALIZED TEMPORARY KERATOPROSTHESES
6. NEW DEVELOPMENTS
7. CONCLUSION
CHAPTER 23:
Vitreoretinal Surgery in Eyes with Permanent Keratoprosthesis
1. INTRODUCTION
2. COMMONLY USED PERMANENT KERATOPROSTHESIS
2.1. The Boston Keratoprosthesis
2.2. Pintucci Biointegrable Keratoprosthesis
2.3. The Osteo-odonto-keratoprosthesis
2.4. The AlphaCor™ KPro
2.5. BioKPro III
2.6. Seoul-type Keratoprosthesis
3. VITREORETINAL COMPLICATIONS ASSOCIATED WITH KPRO
3.1. Retinal Detachment
3.2. Endophthalmitis
3.3. Retro KPro Membranes
4. CHALLENGES IN VITREORETINAL SURGERY IN EYES WITH KERATOPROSTHESIS
4.1. Sclerotomies
4.2. Stability of Optic
4.3. Viewing Systems
4.4. Intraocular Procedures
4.5. Tamponade
4.6. Postoperative Care
4.7. IOP Evaluation
5. CONCLUSION
CHAPTER 24:
Vitreoretinal Surgical Diseases and Refractive Surgery
1. INTRODUCTION
2. RETINAL DETACHMENT
3. MACULAR HEMORRHAGE, LACQUER CRACKS AND CHOROIDAL NEOVASCULAR MEMBRANES
4. MACULAR HOLE
5. DISPLACEMENT OF CORNEAL CAP DURING VITRECTOMY
6. FINAL CONSIDERATIONS
7. TO CONCLUDE
SECTION 4: RETINAL DETACHMENT BASICS
CHAPTER 25:
Peripheral Retinal Lesions, Breaks and their Treatment
1. HISTORY
2. BASICS
2.1. Anatomy
2.1.1. Pars Plana
Surface Marking
2.1.2. Ora Serrata
Surface Marking
2.1.3. Peripheral Retina
Surface Marking
2.1.4. Vitreous Base
2.2. Vitreous Adhesions4
2.2.1. Normal
2.2.2. Abnormal
2.3. Breaks
2.3.1. Definition
2.3.2. Classification Based on Pathogenesis
2.3.3. Classification Based on Morphology
2.3.4. Classification Based on Location
3. PATHOPHYSIOLOGY OF RETINAL DETACHMENT
4. PREDISPOSING LESIONS
4.1. Lattice Degeneration
4.1.1. Prevalence
4.1.2. Pathogenesis
4.1.3. Signs
4.1.4. Natural History
4.1.5. Clinical Significance
4.2. Snail Track Degeneration
4.3. Degenerative Retinoschisis
4.3.1. Prevalence
4.3.2. Pathogenesis
4.3.3. Signs
4.3.4. Natural History
4.3.5. Clinical Significance
4.4. Other Lesions
4.4.1. White with Pressure
4.4.2. White without Pressure
4.4.3. Diffuse Chorioretinal Atrophy
5. BENIGN PERIPHERAL LESIONS
5.1. Paving Stone Degeneration
5.2. Cystoid Degeneration
5.3. Honeycomb Degeneration
5.4. Snow Flake Degeneration
6. SYMPTOMS AND SIGNS4: ASSOCIATED WITH PERIPHERAL RETINAL PATHOLOGY
6.1. Flashes (Photopsia)
6.2. Floaters
6.3. Vitreous Hemorrhage
6.4. Posterior Vitreous Detachment (PVD): Clinical Relevance
7. EXAMINATION TECHNIQUES
7.1. Clear Media
7.2. Opaque Media
8. MANAGEMENT
8.1. To Do or Not to Do
8.2. LASER Photocoagulation
8.2.1. Binocular LASER Indirect Ophthalmoscope (LIO)
8.2.2. LASER Application
8.2.3. Pearls During LASER Application
8.2.4. Slit Lamp Delivery Systems
8.3. Cryotherapy
Advantages of Cryotherapy
Management Pearls
9. CONCLUSION
CHAPTER 26:
The 8 Rules: How to Find the Retinal Break
1. INTRODUCTION
2. PREOPERATIVE SEARCH FOR THE BREAK IN A RETINAL DETACHMENT
2.1. Primary Retinal Break
2.2. The ‘4 Rules’: How to Find the Primary Break
2.2.1. Background
2.2.2. Characteristics of a Rhegmatogenous Retinal Detachment
2.2.3. The ‘4 Rules’: How to Find the Primary Break (Fig. 26.5)
2.2.4. Differential Diagnosis of an “Inferior” Detachment
2.2.5. Conclusion
2.3. Secondary Breaks in a Primary Retinal Detachment
2.4. Characteristics of an Old Detachment
2.5. Importance of a Small Attached Area in the Retinal Periphery
2.6. Problems in the Optic Media
3. PREOPERATIVE SEARCH FOR A MISSED BREAK IN REOPERATION
3.1. The 4 Rules to Find the Missed Break in Reoperation after Buckling (Fig. 26.12)
3.2. Inadequate Tamponade of the Break
3.3. Conclusion
4. DIFFERENTIAL DIAGNOSIS BETWEEN RHEGMATOGENOUS DETACHMENT AND RETINOSCHISIS
4.1. Characteristics of a Rhegmatogenous Retinal Detachment
4.2. Characteristics of a Retinoschisis
5. RHEGMATOGENOUS RETINAL DETACHMENT “WITHOUT” A BREAK
5.1. The 5 Steps to Find the Break in a Detachment “Without a Break”
5.2. Application of a Diagnostic Segmental Circumferential Buckle
5.2.1. Distance from Limbus for a Diagnostic Segmental Buckle
5.3. Conclusion
6. THE SEARCH FOR A RETINAL BREAK IN AN ACUTE VITREOUS HEMORRHAGE
6.1. Characteristics
6.2. Noninvasive Management of Acute “Vitreous” Hemorrhage
7. CONCLUSION
CHAPTER 27:
Primary Retinal Detachment: Review of Techniques for Repair Applied Over the Past 80 Years—A Personal Odyssey
1. INTRODUCTION
2. REVIEW
3. EVOLUTION OF SURGICAL TECHNIQUE
3.1. Refinements in Scleral Buckling
3.1.1. Minimal Extraocular Surgery (Minimal Segmental Buckling without Drainage)
3.1.2. Balloon Operation
3.2. The Introduction of Gases
3.2.1. Sulfur Hexafluoride Gas with Drainage
3.2.2. Expanding Gas Operation without Drainage
3.2.3. The Perfluorocarbon Gases
3.2.4. Pneumatic Retinopexy
3.2.5. Combination: Balloon-Gas Procedure without Drainage
3.3. Vitreous Surgery for Retinal Detachment
3.3.1. Primary Vitrectomy
4. DISCUSSION
CHAPTER 28:
Pneumatic Retinopexy: The Evolution of Case Selection and Procedure
1. INTRODUCTION
2. THE PHILOSOPHY OF PNEUMATIC RETINOPEXY
3. THE PROCEDURE
4. CLINICAL RESULTS
4.1. Anatomic Success
4.2. Visual Recovery
4.3. Complications
4.3.1. Operative Complications
4.3.2. Postoperative Complications
4.4. Reoperations
5. DISCUSSION
5.1. Anatomic Success
5.2. Visual Recovery
5.3. Prognostic Indicators
5.3.1. Pseudophakia
5.3.2. Retinal Detachment Size
5.3.3. Type and Number of Retinal Defects
5.3.4. Gas
5.4. Quality and Cost-effectiveness Measurements
5.5. Optimal Results with Case Selection and the Most Effective Technique
5.5.1. Which Cases Do Best
5.5.2. Why 360° Retinopexy
5.5.3. Follow-up Recommendations
5.6. The Learning Curve
5.7. Comparison with Other Surgical Techniques
6. SUMMARY
CHAPTER 29:
Scleral Buckling
1. INTRODUCTION
2. BUCKLING PRINCIPLES
3. REATTACHMENT FORCES INFLUENCED BY SCLERAL BUCKLES
4. PREOPERATIVE MANAGEMENT
4.1. Eye Patching
4.2. Preoperative Activity and Head Positioning
4.3. Serous Choroidal Detachments
4.4. Prevention of Infection
4.5. Open Angle Glaucoma or Glaucoma Secondary to Retinal Detachment
4.6. Cataract
4.7. Posterior Chamber Intraocular Lens
4.8. Vitreous Hemorrhage
4.9. Anesthesia
5. PREPARATION OF THE SITE
6. PUPILLARY DILATATION AND CORNEAL CLARITY
7. EXPOSURE OF THE OPERATIVE FIELD
8. LOCALIZATION AND INTRAOPERATIVE EXAMINATION
9. TREATING THE BREAKS
9.1. Diathermy
9.2. Cryotherapy
9.3. Photocoagulation
10. METHODS OF BUCKLING
10.1 Explant Techniques
10.1.1. Buckling Materials
10.1.2. Life of the Buckling Effect
10.1.3. Shape of the Buckle
10.1.4. Scleral Suture Techniques
10.1.5. Configuration of the Buckle
10.2. Implant Techniques
10.2.1. Preparation of the Scleral Bed
10.2.2. Diathermy
10.2.3. Buckle Implantation
10.2.4. Advantages and Disadvantages
11. SUBRETINAL FLUID DRAINAGE
11.1. Rationale
11.2. Selection of the Drainage Site
11.3. Drainage Technique
11.3.1. Radial Sclerotomy and External Observation of the Drainage Site
11.3.2. External Needle Drainage
11.4. Adjusting Intraocular Volume
12. ADJUSTMENT OF THE SCLERAL BUCKLE
13. ASSURING PERFUSION OF CENTRAL RETINAL ARTERY
14. NONDRAINAGE PROCEDURE
15. CLOSURE OF INCISIONS
16. POSTOPERATIVE MANAGEMENT
16.1. Medications
16.2. Patching
16.3. Examination
16.4. Activity
17. OUTCOMES
17.1. Anatomic Results
17.2. Visual Results
18. SCLERAL BUCKLING VERSUS PRIMARY VITRECTOMY
18.1. For Uncomplicated Retinal Detachments
18.1.1. Break Characteristics
18.1.2. Age and Posterior Vitreous Detachment
18.1.3. Lens Status
18.1.4. Pseudophakic and Aphakic Patients
18.1.5. Media
18.2. Results
18.3. Surgeon Factor
18.4. The Fear Factor
19. SUMMARY
1. INTRODUCTION
2. INTRAOPERATIVE COMPLICATIONS
2.1. Complications Associated with Anesthesia
2.2. Complications During Exposure
2.2.1. Rectus Muscle Rupture
2.3. Complications Reducing Visualization
2.3.1. Corneal Clouding
2.3.2. Miosis
2.3.3. Hyphema
2.3.4. Intravitreal Gas Injection
2.4. Complications of Localization
2.5. Complications of Treatment
2.6. Complications of Scleral Sutures
2.7. Complications during Subretinal Fluid Drainage
2.7.1. Intraocular and Choroidal Hemorrhage
2.7.2. Retinal Perforation
2.7.3. Retinal Incarceration
2.7.4. Dry Tap
2.7.5. Late Subretinal Choroidal Neovascularization
2.8. Complications of Scleral Buckling
3. POSTOPERATIVE COMPLICATIONS
3.1. Glaucoma
3.1.1. Secondary Open Angle Glaucoma
3.1.2. Angle Closure Glaucoma
3.2. Choroidal Detachment
3.3. Hemorrhagic Choroidal Detachment
3.4. Anterior Segment Ischemia
3.5. Failure to Reattach
3.5.1. Persistent Subretinal Fluid
3.6. Exudative Retinal Detachment
3.7. Proliferative Vitreoretinopathy
3.8. Infection and Extrusion
Management
3.9. Cystoid Macular Edema
3.10. Macular Pucker
3.11. Motility Disturbances and Strabismus
3.12. Changes in Refractive Error
3.13. Endophthalmitis
3.14. Intrusion or Transscleral Erosion of Buckle
3.15. Other Complications
4. CONCLUSION
CHAPTER 30:
Minimal Extraocular Surgery with Sponge(s) and Balloon for Repair of Rhegmatogenous Retinal Detachment
1. INTRODUCTION
2. HISTORICAL BACKGROUND OF MINIMAL EXTRAOCULAR SURGERY (SEGMENTAL SPONGE BUCKLE(S) WITHOUT DRAINAGE)
3. DIFFICULTIES IN ACCEPTANCE OF THE CRYOSURGICAL DETACHMENT OPERATION
4. MINIMAL EXTRAOCULAR SURGERY WITH SEGMENTAL SPONGE BUCKLE(S) WITHOUT DRAINAGE
4.1. Development and Specifics
4.2. Optimal Orientation of a Segmental Sponge Buckle
4.3. Surgical Technique and Essentials
4.4. Limits of Minimal Segmental Sponge Buckle(s) without Drainage
4.4.1. First Category of Difficult Detachments
4.4.2. Second Category of Difficult Detachments
4.4.3. Third Category of Difficult Detachments
4.5. Complications
5. MINIMAL EXTRAOCULAR SURGERY WITH A TEMPORARY BALLOON BUCKLE WITHOUT DRAINAGE
5.1. Development and Specifics
5.2. Surgical Technique and Essentials
5.3. Difficulties to Accept the Balloon Operation
5.4. Applications of the Temporary Balloon Buckle
5.5. Advantages of the Balloon Operation
6. CLINICAL RESULTS OF MINIMAL EXTRAOCULAR SURGERY WITH SPONGE BUCKLE(S) OR BALLOON
6.1. Materials and Methods
6.2. Applied Surgical Technique
6.3. Differential Diagnosis of Postoperative Residual Detachment
6.3.1. Convex Residual Detachment
6.3.2. Concave Residual Detachment
6.3.3. Convex Rhegmatogenous Residual Detachment
6.4. Anatomical Results
6.5. Reasons for Primary and Final Failure
6.5.1. Missed Breaks
6.5.2. Inadequate Buckles
6.5.3. Proliferative Vitreoretinopathy
6.5.4. Choroidals
6.6. Complications
6.6.1. Intraocular
6.6.2. Extraocular
6.7. Functional Results
6.7.1. During 2-Year Follow-up
6.7.2. During 15-Year Follow-up
6.7.3. Conclusion
6.8. Minimal Extraocular Surgery for Detachments with PVR Stage B, C1 and C2
6.8.1. Historical Background
6.8.2. Clinical Study
6.8.3. Functional Results
6.9. Minimal Extraocular Surgery for Reoperation
6.9.1. Preoperative Examination
6.10. Reoperation
6.10.1. The Four Patterns of Detachment for Reoperation Finding the Missed Break
6.11. An Inadequate Buckle
6.12. Surgical Technique
6.13. Results
6.14. Disadvantages of Minimal Extraocular Surgery
6.15. Advantages of Minimal Extraocular Surgery
7. DISCUSSION
8. OUTLOOK
CHAPTER 31:
Primary Vitrectomy for Rhegmatogenous Retinal Detachment
1. INTRODUCTION
2. INDICATIONS
3. TECHNIQUES
3.1. Vitrectomy
3.2. Combined Pars Plana Vitrectomy and Scleral Buckling
3.3. Tamponade
3.4. Postoperative Positioning
3.5. Special Situations
3.5.1. Previous Refractive Surgery
3.5.2. Patients with a Retinal Break that is not seen Preoperatively
3.5.3. Rhegmatogenous Retinal Detachment with Proliferative Vitreoretinopathy of Grade C or Greater
3.5.4. Giant Retinal Tear
4. COMPLICATIONS UNIQUE TO THIS SURGICAL TECHNIQUE
4.1. Intraoperative Complications and their Avoidance
4.2. Postoperative Complications
CHAPTER 32:
Repair of Primary Retinal Detachment: Comparison of Present Surgical Techniques
1. INTRODUCTION
2. COMPARISON OF PRESENT SURGICAL TECHNIQUES FOR REPAIR OF A PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT
2.1. Pneumatic Retinopexy versus Temporary Balloon Buckle
2.2. Pneumatic Retinopexy versus Primary Vitrectomy
2.3. Primary Vitrectomy Versus Extraocular Minimal Surgery
2.4. Intraocular versus Extraocular Surgery
3. SUMMARY
4. OUTLOOK
SECTION 5: RETINAL DETACHMENT ADVANCED
CHAPTER 33:
Proliferative Vitreoretinopathy
1. INTRODUCTION
2. EPIDEMIOLOGY AND RISK FACTORS
3. PATHOPHYSIOLOGY
4. CLASSIFICATION
5. DIAGNOSIS
6. MANAGEMENT
6.1. Scleral Buckle
6.2. Vitreous Surgery
6.2.1. Scleral Buckling
6.2.2. Vitreous Removal
6.2.3. Posterior Epiretinal Membrane Removal
6.2.4. Excision of the Vitreous Base and Anterior Epiretinal Membrane Removal
6.2.5. Injection of Perfluorocarbon Liquids
6.2.6. Subretinal Membrane Removal
6.2.7. Treatment of Retinal Breaks
6.2.8. Scleral Buckle Placement
6.2.9. Intraocular Tamponade
6.3. Special Considerations
6.3.1. Lens Management
6.3.2. Pupil Management
6.3.3. Relaxing Retinotomy/Retinectomy
6.3.4. Heavy Silicone Oil
6.3.5. Sutureless Vitrectomy
7. PREVENTION
7.1. Corticosteroids
7.2. Antineoplastic Agents
7.3. Other Antiproliferative Agents
8. CONCLUSION
CHAPTER 34:
Retinal Detachment Secondary to Giant Retinal Tear
1. INTRODUCTION
2. CAUSE
3. VITREORETINAL RELATIONSHIP
4. MANAGEMENT
4.1. Preoperative Evaluation
4.2. Surgery
4.2.1. Anesthesia
4.2.2. Lens Removal
4.2.3. Vitrectomy
4.2.4. Retinopexy
4.2.5. Intraocular Tamponade
4.2.6. Scleral Buckling
4.3. Postoperative Patient Positioning and Management
5. RESULTS
6. COMPLICATIONS
7. MANAGEMENT OF THE FELLOW EYE
8. CONCLUSION
CHAPTER 35:
Management of Rhegmatogenous Retinal Detachment with Inferior Breaks
1. HISTORICAL PERSPECTIVE
2. RELEVANT PATHOPHYSIOLOGY
3. BRIEF CLINICAL FEATURES
4. BRIEF SUMMARY OF SURGICAL OPTIONS WITH VITRECTOMY TECHNIQUES
4.1 Pars Plana Vitrectomy Alone
4.1.1. Indications
4.2. Pars Plana Vitrectomy Combined With Scleral Buckling
4.2.1. Indications
5. PATIENT PREPARATION
6. SURGICAL TECHNIQUE
6.1. Illuminated Infusion Line
6.2. Identification of Cortical Vitreous and Vitreous Base
6.3. Schlieren Effect
6.4. Drainage of Subretinal Fluid
6.5. Innovations
6.5.1. Illumination systems
6.5.2. Field of view
7. POSTOPERATIVE FOLLOW-UP
8. COMPLICATIONS
8.1. Intraoperative
8.2. Postoperative
9. RESULTS
10. SUMMARY
CHAPTER 36:
Retinal Detachment due to Macular Hole
1. INTRODUCTION
2. ETIOPATHOGENESIS
3. PREOPERATIVE EVALUATION
4. VITREOUS SURGERY TECHNIQUE
4.1. Role of Internal Limiting Membrane Peeling
5. PROGNOSIS
6. MACULAR BUCKLING
7. PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT WITH ASSOCIATED MACULAR HOLE
8. CONCLUSION
CHAPTER 37:
Surgery for Recurrent Retinal Detachment
1. INTRODUCTION
2. ASSESSMENT: THE FIRST STEP
3. RESURGERY CONSIDERATIONS
4. TIMING OF RESURGERY
5. TECHNIQUES
5.1. Placement of Scleral Buckle
5.2. Placing the Infusion Port
5.3. Intraocular Lens and Lens Removal
5.4. Proliferative Vitreoretinopathy Pattern in Failed Detachment Surgeries
5.5. Peeling Proliferative Vitreoretinopathy Membranes
5.6. Assessing Residual Vitreous Traction
5.7. Performing Retinectomies
5.8. Removal of Subretinal Bands
5.9. Bimanual Surgery
5.10. Inferior Grid Barrage
6. CHOICE OF TAMPONADE
7. POSTOPERATIVE USE OF STEROIDS
8. CONCLUSION
SECTION 6: DIABETIC RETINOPATHY COMPLICATIONS
CHAPTER 38:
Vitreous Surgery in Diabetic Retinopathy
1. INTRODUCTION
2. INDICATIONS
3. REPRESENTATIVE CLINICAL SITUATIONS
Situation 1: Mild to Moderate Vitreous Hemorrhage in Unlasered Patient, No RD on Ultrasound Imaging
Situation 2: Dense Vitreous Hemorrhage
Situation 3: Dense Hemorrhage, No Early Clearing
Situation 4: Dense Vitreous Hemorrhage, Bilateral or with Severe Visual Impairment in the Fellow Eye
Situation 5: Nasal TRD with Good Vision, Stable TRD with Good Vision or Burnt Out Proliferation
Situation 6: Anterior Segment Neovascularization
Situation 7: Diabetic Macular Edema (DME)
4. SURGICAL STEPS
5. RESULTS
6. COMPLICATIONS
7. CONCLUSION
CHAPTER 39:
Recurrent Diabetic Vitreous Hemorrhage: Risk Factors and Management
1. INTRODUCTION
2. RECURRENT VITREOUS HEMORRHAGE IN A NONVITRECTOMIZED EYE
2.1. Risk Factors of Recurrent Vitreous Hemorrhage
2.1.1. Systemic Risk Factors
2.1.2. Local Risk Factors
2.2. Prevention and Management
3. RECURRENT VITREOUS HEMORRHAGE IN A VITRECTOMIZED EYE
3.1. Risk Factors of Postoperative Recurrent Vitreous Hemorrhage
3.1.1. Systemic Risk Factors
3.1.2. Local Risk Factors and Bleeding Sources
3.2. Prevention and Management
3.2.1. Preoperative Considerations
3.2.2. Intraoperative and Early Postoperative Measures
Avoidance of vascular injury
Reduction of vitreous blood and the amount of blood clots at the end of surgery
Eliminating vitreoretinal traction and fibrovascular proliferation tissue as thoroughly as possible
Preventing the development of neovascularization at the vitreous base, anterior segment, and sclerotomy sites
3.3. Management of Recurrent Vitreous Hemorrhage
4. SUMMARY
CHAPTER 40:
Epiretinal Membrane Management in Proliferative Diabetic Retinopathy
1. INTRODUCTION
2. PATHOANATOMY AND PRINCIPLES
3. SURGICAL TECHNIQUE
3.1. Vitrectomy and Initiation of Membrane Removal
3.2. Scissors Segmentation and Delamination
3.3. Cutter Delamination of Epiretinal Membranes
3.4. Inside-Out versus Outside-In Technique
3.5. Viscodissection
3.6. Hemostasis
3.7. Silicone Oil
3.8. Liquid Perfluorocarbon
4. SUMMARY
CHAPTER 41:
Bimanual Surgery for Diabetic Retinopathy and Vascular Disorders
1. INTRODUCTION
2. PATHOGENESIS
3. PATHOANATOMY
3.1. Vitreoschisis
3.2. Degree of Posterior Vitreous Separation
3.3. Types of Vitreoretinal Adhesion
4. BIMANUAL SURGERY CONSIDERATIONS
4.1. Development
4.2. Microincision Vitrectomy System
4.3. Viewing System
4.4. Endoillumination
5. SURGERY
5.1. Preoperative Considerations
5.1.1. Systemic Assessment
5.1.2. Ocular Assessment
5.2. Operative Procedure
5.2.1. Cataract Extraction
5.2.2. Sclerotomies
5.2.3. Vitrectomy
5.2.4. Membrane Removal
6. COMPLICATIONS
6.1. Phototoxicity
6.2. Postoperative Vitreous Hemorrhage
7. SUMMARY
CHAPTER 42:
Vitrectomy for Diabetic Macular Edema
1. INTRODUCTION
2. PATHOPHYSIOLOGY
2.1. Role of the Vitreous and Vitreoschisis
3. SURGICAL INDICATIONS BASED ON ULTRASTRUCTURAL FINDINGS
3.1. Posterior Vitreous Cortex Abnormalities
3.2. Epiretinal Membrane Formation
4. SURGICAL TECHNIQUES
5. COMPLICATIONS
6. RESULTS OF VITRECTOMY IN DIABETIC MACULAR EDEMA
7. NEW DEVELOPMENTS
8. PEARLS
SECTION 7: MACULAR DISORDERS
CHAPTER 43:
Epiretinal Membranes
1. INTRODUCTION
2. EPIDEMIOLOGY
3. PATHOPHYSIOLOGY3,4
4. CLASSIFICATION5
5. RISK FACTORS AND ETIOLOGY
6. DIAGNOSIS
6.1. Symptoms
6.2. Signs
6.3. Optical Coherence Tomography
6.4. Ancillary Tests
7. SURGERY
7.1. Surgical Procedure
7.2. Surgical Results
7.3. Prognostic Factors for Surgery
8. COMPLICATIONS
9. CONCLUSION
CHAPTER 44:
Macular Holes
1. HISTORICAL PERSPECTIVE
2. PATHOPHYSIOLOGY
3. CLINICAL FEATURES
4. MANAGEMENT
4.1. Mechanism of Hole Closure
4.2. Indications and Timing
4.3. Surgical Technique
4.4. Complications
5. RESULTS
6. NEW DEVELOPMENTS
7. SUMMARY
CHAPTER 45:
Premacular Hemorrhage
1. INTRODUCTION
2. ANATOMY AND PATHOPHYSIOLOGY
2.1. Location
2.2. Pathophysiology
3. CLINICAL FEATURES
4. MANAGEMENT
4.1. Pneumatic Displacement
4.2. Laser Hyaloidotomy
4.3. Vitrectomy
5. SUMMARY
CHAPTER 46:
Submacular Hemorrhage
1. INTRODUCTION
2. ETIOLOGY
3. CLINICAL FEATURES
4. NATURAL HISTORY
5. PROGNOSTIC FACTORS
5.1. Size
5.2. Duration
5.3. Disease Process
6. MANAGEMENT OF SUBMACULAR HEMORRHAGE
6.1. Treatment Options
6.1.1. Vitrectomy and Evacuation (without Tissue Plasminogen Activator)
6.1.2. Vitrectomy and t-PA Assisted Evacuation
6.1.3. Pneumatic Displacement—Intravitreal Gas and t-PA
6.1.4. Pneumatic Displacement—Intravitreal Gas Alone (without t-PA)
6.1.5. Intravitreal t-PA with Pneumatic Displacement and Anti-VEGF Agents
6.2. Complications
6.2.1. Procedure Related
6.2.2. Toxicity of rt-PA
7. SUMMARY AND RECOMMENDATIONS
7.1. Small Hemorrhage
7.2. Moderate-sized Hemorrhage
7.3. Large Hemorrhage
SECTION 8: LENS AND IOL-RELATED DISORDERS
CHAPTER 47:
Lensectomy
1. INTRODUCTION
2. INDICATIONS
3. PREOPERATIVE EVALUATION
4. SURGICAL TECHNIQUE
4.1. Removal of Soft Lens
4.2. Removal of Hard Lens
5. CONCLUSION
CHAPTER 48:
Management of Retained Lens Material
1. INTRODUCTION
2. PATHOPHYSIOLOGY AND RISK FACTORS
3. CLINICAL FEATURES
4. INDICATION AND TIMING OF SURGICAL INTERVENTION
5. VITREORETINAL SURGICAL TECHNIQUE
6. POSTOPERATIVE MANAGEMENT AND COMPLICATIONS
7. RESULTS OF VITRECTOMY MANAGEMENT
8. SUMMARY
CHAPTER 49:
Management of Dislocated Intraocular Implants
1. INTRODUCTION
2. FACTORS ASSOCIATED WITH IOL DISLOCATION
3. MANAGEMENT
3.1. Observation
3.2. IOL Removal or Exchange
3.3. Repositioning of the Dislocated IOL
4. TECHNIQUES
4.1. Scleral Fixation
4.1.1. External Approach Techniques
4.1.2. Internal Approach
4.2. Management with Perfluorocarbon Liquids
4.3. Management with Endoscopy
4.4. Management of Dislocated Plate—Haptic IOL
4.5. Management of Double Intraocular Implants
4.6. Management of Posteriorly Dislocated Capsular Tension Ring with or without IOL Complex
5. COMPLICATIONS OF SCLERAL FIXATION
6. SUTURELESS FIXATION OF THE DISLOCATED IMPLANT
7. CONCLUSION
CHAPTER 50:
Surgical Management of Aphakia
1. INTRODUCTION
2. OPTICS OF APHAKIA
3. OPTIONS FOR APHAKIC CORRECTION
3.1. Spectacle Correction
3.2. Contact Lenses
3.3. Refractive Corneal Surgery
3.4. Secondary Intraocular Lens Implantation
3.4.1. Anterior Chamber Intraocular Lens
3.4.2. Iris-fixated IOL
3.4.3. Posterior Chamber IOL
4. CASE SELECTION FOR SECONDARY IOL IMPLANT
5. PREOPERATIVE EVALUATION
6. SURGICAL TECHNIQUES
6.1. Secondary PCIOL
6.1.1. Procedure
6.1.2. Complications
6.2. Iris-fixated Lens
6.2.1. Procedure
6.2.2. Complications
6.3. Transscleral Suture Fixation of IOL in the Ciliary Sulcus
6.3.1. Selection of the IOL
6.3.2. Techniques for SFIOL
6.3.3. Role of Ultrasound Biomicroscopy
6.3.4. Complications of SFIOL
7. POSTOPERATIVE MANAGEMENT
8. SUMMARY
CHAPTER 51:
Management of Postoperative Endophthalmitis
1. INTRODUCTION
2. PATHOPHYSIOLOGY AND CLASSIFICATION
3. CLINICAL FEATURES
4. INCIDENCE RATES AND RISK FACTORS
5. SURGICAL PRINCIPLES
6. RESULTS
7. KEY POINTS
SECTION 9: TRAUMA AND COMPLICATIONS
CHAPTER 52:
Anterior Segment Management in Eyes with Trauma
1. INTRODUCTION
2. CONJUNCTIVAL LACERATION
3. CORNEAL AND SCLERAL LACERATIONS2,3
3.1 Partial-thickness Corneal Lacerations
3.2 Full-thickness Corneal Lacerations
3.3 Corneoscleral and Scleral Lacerations
4. IRIS RECONSTRUCTION
5. PUPIL REPAIR
6. CONCLUSION
CHAPTER 53:
Traumatic Vitreous Hemorrhage
1. INTRODUCTION
2. BRIEF HISTORICAL PERSPECTIVE
3. ANATOMY
4. ETIOPATHOGENESIS
4.1. Closed Globe Injury
4.1.1. Retinal Tear/Dialysis
4.1.2. Vitreous Base Avulsion
4.1.3. Optic Nerve Avulsion
4.1.4. Sclopetaria
4.1.5. Choroidal Rupture
4.2. Open Globe Injury
4.3. Terson's Syndrome
4.4. Shaken Baby Syndrome
5. CLINICAL FEATURES
6. IMAGING STUDIES
7. MEDICAL THERAPY
8. SURGICAL MANAGEMENT
8.1. Indications of Surgery
8.2. Surgery
8.3. Complications
9. PROGNOSIS
10. CONCLUSION
CHAPTER 54:
Intraocular Foreign Body
1. INTRODUCTION
2. EPIDEMIOLOGY
3. EVALUATION
4. MECHANISMS OF INJURY
4.1. Mechanical
4.2. Chemical
4.2.1. Siderosis
4.2.2. Chalcosis
4.3. Biological
4.4. Secondary Damage
5. MANAGEMENT
5.1. Principles
5.1.1. Timing: Early Versus Delayed Removal
5.1.2. Prophylactic Antibiotics
5.2. Anterior Segment IOFB
5.3. Posterior Segment IOFBs
6. PROGNOSIS AND OUTCOME
7. CONCLUSION
CHAPTER 55:
Post-traumatic Endophthalmitis
1. INTRODUCTION
2. EPIDEMIOLOGY
3. RISK FACTORS FOR POST-TRAUMATIC ENDOPHTHALMITIS
3.1. Intraocular Foreign Body
3.2. Lens Rupture
3.3. Nature of Trauma
3.4. Delay in Treatment
4. CLINICAL DIAGNOSIS
5. FACTORS AFFECTING VISUAL PROGNOSIS
5.1. Retinal Detachment
5.2. Intraocular Foreign Body
5.3. Virulence of the Organism
6. MANAGEMENT
6.1. Antibiotics
6.1.1. Intravitreal Antibiotics
6.1.2. Systemic Antibiotics
6.1.3. Other Routes
6.2. Steroids
6.3. Vitrectomy
7. COMPLICATIONS
8. OUTCOMES
9. CONCLUSION
SECTION 10: PEDIATRIC RETINAL SURGERY
CHAPTER 56:
Principles of Pediatric Retinal Detachment Surgery
1. INTRODUCTION
2. CHALLENGES UNIQUE TO PEDIATRIC RETINAL DETACHMENT
3. DEVELOPMENTAL CONSIDERATIONS
4. CLINICAL PRESENTATION
5. SURGICAL APPROACH
5.1. Principles of Management
6. SPECIFIC CLINICAL SITUATIONS
6.1. Familial Exudative Vitreoretinopathy
6.2. Persistent Hyperplastic Primary Vitreous/Persistent Fetal Vasculature Syndrome2,3
6.2.1. Management
6.3. Retinoschisis4
6.3.1. Clinical Features
6.3.2. Management
6.4. Surgery in Older Children
6.4.1. Indications
7. SPECIFIC CONCERNS IN PEDIATRIC VITREORETINAL SURGERY
8. DECISION-MAKING FOR PROPHYLACTIC TREATMENT IN PEDIATRIC RETINAL DISORDERS
9. POSTOPERATIVE MANAGEMENT
CHAPTER 57:
Surgical Management of Stages 4 and 5 Retinopathy of Prematurity
1. INTRODUCTION
2. OPTIONS FOR TREATMENT
2.1. Observation
2.2. Timing of Surgery for Stage 4A
2.3. Surgical Goals in ROP Surgery
2.4. Surgical Procedure
2.4.1. Stage 4
2.4.2. Stage 5
2.5. Our Experience
2.6. Vitrectomy After Intravitreal Bevacizumab for Retinal Detachment in ROP
2.7. Rehabilitation
3. CONCLUSION
CHAPTER 58:
Surgery for Choroidal Coloboma and Retinal Detachment
1. INTRODUCTION
2. ANATOMICAL CONSIDERATIONS
3. CLINICAL PRESENTATION OF RETINAL DETACHMENT
3.1. Retinal Breaks, Intercalary Membrane Breaks and Breaks at Locus Minoris Resistentiae
3.2. Characteristics of the Retinal Detachment
4. MANAGEMENT
4.1. Steps of Surgical Procedure
4.2. Causes of Failure of Surgery
5. RESULTS
SECTION 11: POSTERIOR SEGMENT TUMORS
CHAPTER 59:
Intraocular Biopsy Techniques
1. INTRODUCTION
2. PREREQUISITES
2.1. Indications
2.2. Contraindications
3. BIOPSY TECHNIQUES
3.1. Aqueous Tap
3.1.1. Indications
3.1.2. Equipment
3.1.3. Procedure
3.1.4. Complications
3.2. Vitreous Tap
3.2.1. Indications
3.2.2. Equipment
3.2.3. Procedure
3.2.4. Diagnostic Vitrectomy
3.2.5. Specimen Handling and Processing
3.2.6. Complications
3.3. Fine Needle Aspiration Biopsy
3.3.1. Indications
3.3.2. Prerequisites
3.3.3. Materials
3.3.4. Procedure
3.3.5. Routes of Approach for FNAB
3.3.6. Specimen Handling
3.3.7. Complications
3.4. Endoiridal Biopsy
3.5. Chorioretinal Biopsy
3.5.1. Indications
3.5.2. Prerequisites
3.5.3. Procedure
3.5.4. Complications
3.6. Excision Biopsy
3.6.1. Anterior Segment Tumors
3.6.2. Posterior Segment Tumors
4. CONCLUSION
CHAPTER 60:
Resection of Intraocular Tumors
1. INTRODUCTION
2. INDICATIONS FOR RESECTION
2.1. Endoresection
2.2. Iris Tumors
2.3. Ciliochoroidal Tumors
3. SURGICAL TECHNIQUE
3.1. Preoperative Preparation
3.2. Anesthesia
3.3. Iridectomy
3.3.1. Complications
3.4. Iridocyclectomy
3.4.1. Technique
3.5. Partial Lamellar Sclerouvectomy (PLSU)
3.5.1. Technique
3.6. Full Thickness Eye Wall Resection
3.6.1. Technique
3.7. Complications of Exoresection
3.8. Endoresection
3.8.1. Technique30
CHAPTER 61:
Ophthalmic Brachytherapy
1. INTRODUCTION
2. BRACHYTHERAPY STEPS
2.1. Selection of Isotopes
2.2. Selection of Plaques
2.3. Dosimetry
2.4. Preparation of Plaque
2.5. Surgical Procedure
3. OUR SURGICAL RESULTS
3.1. Choroidal Melanomas
3.2. Retinoblastoma
3.3. Vasoproliferative Tumor
4. COMPLICATIONS
CHAPTER 62:
Enucleation Technique, Orbital Implants and Complications
1. INTRODUCTION
2. PROCEDURE RATES AND INDICATIONS
3. SURGICAL TECHNIQUES
3.1. Preoperative Care
3.2. Intraoperative Technique
3.3. Postoperative Care
4. COMPLICATIONS
4.1. Intraoperative Complications
4.1.1. Removal of the Wrong Eye
4.1.2. Loss of Extraocular Muscles
4.1.3. Orbital Hemorrhage
4.2. Postoperative Complications
4.2.1. Early Complications
4.2.2. Late Complications
5. ORBITAL IMPLANT SELECTION
5.1. Nonintegrated or Nonporous Implants
5.2. Integrated or Porous Orbital Implants
5.3. Comparison of Prosthesis and Implant Motility between the Porous and Nonporous Orbital Implants
SECTION 12: VITREORETINAL INTERVENTION IN UVEITIC DISORDERS
CHAPTER 63:
Management of Viral Retinitis
1. INTRODUCTION
2. CYTOMEGALOVIRUS RETINITIS
2.1. Foscarnet Therapy for Cytomegalovirus Retinitis
2.2. Cidofovir Therapy for Cytomegalovirus Retinitis
2.3. Rhegmatogenous Retinal Detachment in Treated Cytomegalovirus Retinitis
2.4. Immune Recovery Uveitis
3. ACUTE RETINAL NECROSIS SYNDROME
4. HERPES SIMPLEX VIRUS RETINITIS
5. SURGICAL APPROACH TO RETINITIS
5.1. Diagnostic Aspiration
5.2. Pars Plana Vitrectomy
5.3. Transscleral Biopsy
5.4. Endoretinal Biopsy
5.5. Retinal Detachment Repair
6. CONCLUSION
CHAPTER 64:
Vitrectomy in Non-infective Uveitis
1. INTRODUCTION
2. INDICATIONS
3. ROLE OF VITREOUS SURGERY IN UVEITIS
3.1. Restoring Optical Clarity
3.2. Relieving Vitreomacular Interface Distortion
3.3. Relieving Tractional Forces
3.4. Removing the Vitreous and hence the Intraocular ‘Sump’ for Inflammatory Mediators
3.5. Identifying the Correct Etiology (from the Vitreous/Retinochoroidal Sample) and Enabling Appropriate Treatment
3.6. Vitreous Biopsy
3.7. Reattachment of a Detached Retina
4. CONSIDERATIONS IN UVEITIC VITRECTOMY
4.1. Age
4.2. Systemic Ailments
4.3. Preoperative Medication
4.4. Hypotony
4.5. Non-dilating Pupil
4.6. Pupillary Membrane
4.7. Retrolental Membrane
4.8. Co-existing Cataract
4.9. Posterior Capsular Opacification
4.10. Posterior Vitreous Detachment
4.11. Wound Closure
5. OUTCOMES
6. CONCLUSION
SECTION 13: INTRAVITREAL INJECTIONS AND LASERS
CHAPTER 65:
Intravitreal Injections: Procedure and Protocol
1. INTRODUCTION
2. GUIDELINES
2.1. Care and Prophylaxis before Injection
2.2. Peri-injection Management
2.2.1. Preparing a Safe Injection Field
2.2.2. Injection Procedure
2.3. Postinjection Management
2.4. Follow-up
3. COMPLICATIONS OF INTRAVITREAL INJECTION PROCEDURE
3.1. Endophthalmitis
3.1.1. Prevention of Endophthalmitis
3.2. Retinal Detachment
4. SPECIAL CONSIDERATIONS
4.1. Anticoagulants
4.2. Bilateral Injections
4.3. Systemic Safety Issues with Intravitreal Injections
5. CONCLUSION
CHAPTER 66:
Intraocular Anti-Vascular Endothelial Growth Factor Therapy
1. BACKGROUND AND INTRODUCTION
2. VEGF INHIBITORS
2.1. Direct VEGF Inhibitors
2.2. VEGFR Inhibitors
2.3. Small Interfering RNA
2.4. Tyrosine Kinase Inhibitors
2.5. Monoclonal Antibodies
3. LANDMARK CLINICAL TRIALS
4. NON-AGE-RELATED MACULAR DEGENERATION (AMD) AND FUTURE APPLICATIONS OF ANTI-VEGF AGENTS
5. PROCEDURE
6. CONCLUSION
CHAPTER 67:
Intravitreal Corticosteroids
1. INTRODUCTION
2. MECHANISM OF ACTION
3. TRIAMCINOLONE ACETONIDE
3.1. Technique of IVTA Injection
3.2. Indications
3.2.1. Diabetic Macular Edema
3.2.2. Macular Edema Associated with Retinal Vein Occlusion
3.2.3. Exudative Macular Degeneration
3.2.4. Noninfectious Posterior Uveitis
3.2.5. Pseudophakic Cystoid Macular Edema
3.2.6. Cystoid Macular Edema Associated with Other Conditions
3.2.7. Miscellaneous
3.2.8. Proliferative Diabetic Retinopathy
3.2.9. Surgical Adjunct
3.3. Adverse Effects
3.3.1. Intraocular Pressure Elevation
3.3.2. Cataract
3.3.3. Endophthalmitis
4. DEXAMETHASONE
5. SUSTAINED RELEASE DRUG DELIVERY
5.1. Fluocinolone Acetonide Sustained Release Drug Delivery
5.2. Dexamethasone Sustained Release Drug Delivery
5.3. Triamcinolone Sustained Release Drug Delivery
5.4. Corticosteroid Prodrug Implant
6. SUMMARY
CHAPTER 68:
Lasers in Choroidal Neovascular Membranes
1. INTRODUCTION
2. THERMAL LASER
2.1. Background
2.2. Mechanism of Action
2.3. The Macular Photocoagulation Study
2.3.1. Extrafoveal Choroidal Neovascular Membranes
2.3.2. Juxtafoveal Choroidal Neovascular Membranes
2.3.3. Subfoveal Choroidal Neovascular Membranes
2.4. Technique of Laser Photocoagulation
2.5. Current Practical Applications
3. TRANSPUPILLARY THERMOTHERAPY
3.1. Background
3.2. Mechanism of Action
3.3. Studies
3.4. Technique of Transpupillary Thermotherapy
3.5. Current Practical Applications
4. PHOTODYNAMIC THERMOTHERAPY
4.1. Background
4.2. Mechanism of Action
4.2.1. Photosensitizing Agents
4.2.2. Light
4.3. Studies
4.3.1. Photodynamic Therapy Study
4.3.2. Verteporfin in Photodynamic Therapy Study
4.4. Procedure
4.5. Current Practical Applications
5. CONCLUSION
SECTION 14: VITREORETINAL SURGERY AND GLAUCOMA
CHAPTER 69:
Management of Postvitrectomy Glaucoma
1. INTRODUCTION
2. MECHANISM OF GLAUCOMA
2.1. Vitreous Surgery
2.1.1. Acute Rise in Intraocular Pressure
2.1.2. Chronic Rise in Intraocular Pressure
2.2. Scleral Buckling
2.3. Intravitreal Expansile Gas
2.4. Silicone Oil
3. SURGICAL PROCEDURES FOR POSTVITRECTOMY GLAUCOMA
3.1. Trabeculectomy
3.2. Glaucoma Shunt Procedures
3.3. Cyclodestructive Procedures
3.4. Retinectomy
3.5. Cyclodialysis
4. CONCLUSION
CHAPTER 70:
Choroidal Detachment
1. INTRODUCTION
2. CAUSES OF CHOROIDAL DETACHMENT
3. DIAGNOSIS AND ASSESSMENT OF A TYPICAL CASE OF SEROUS CHOROIDAL DRAINAGE
4. MANAGEMENT OF SEROUS CHOROIDAL DETACHMENTS
4.1. Indications for Choroidal Drainage
4.2. Technique of Choroidal Drainage
4.2.1. Combined Choroidal Detachment with Retinal Detachment
4.2.2. Nonresolving Choroidal Detachments Post-filtration Surgery
5. COMPLICATIONS
6. CONCLUSION
CHAPTER 71:
Suprachoroidal Hemorrhage
1. INTRODUCTION
2. PATHOPHYSIOLOGY
3. INCIDENCE
4. PREDISPOSING FACTORS
5. PROPHYLAXIS
6. RECOGNITION (INTRAOPERATIVE DIAGNOSIS)
7. EMERGENCY MANAGEMENT (INTRAOPERATIVE MANAGEMENT)
8. POSTOPERATIVE MANAGEMENT
9. SURGICAL MANAGEMENT
9.1. Drainage
10. POSTOPERATIVE MANAGEMENT
11. PROGNOSIS
CHAPTER 72:
Malignant Glaucoma
1. INTRODUCTION
2. EYES AT RISK
3. PATHOPHYSIOLOGY
4. MANAGEMENT PRINCIPLES
4.1. Vitrectomy in Malignant Glaucoma Considerations
4.2. Results
5. CONCLUSION
CHAPTER 73:
Neovascular Glaucoma: Vitreoretinal Perspective
1. INTRODUCTION
2. ETIOLOGY
3. PATHOGENESIS
4. PRESENTATION
5. TREATMENT
5.1. Panretinal Photocoagulation
5.2. Panretinal Cryotherapy
5.3. Intravitreal Anti-vascular Endothelial Growth Factor Injections
5.4. Vitrectomy with Retinal Ablation
5.5. Cycloablative Procedures
6. SUMMARY (Flowchart 73.1)
6.1. Prerubeotic Stage
6.2. Rubeosis Iridis
6.3. Neovascular Glaucoma
6.3.1. Open Angle
6.3.2. Closed Angle
SECTION 15: EMERGING TECHNIQUES
CHAPTER 74:
Surgery for Age-related Macular Degeneration
1. HISTORICAL BACKGROUND
2. PNEUMATIC DISPLACEMENT OF SUBMACULAR HEMORRHAGE
3. SURGICAL EVACUATION OF SUBRETINAL HEMORRHAGE
3.1. Surgical Technique
3.2 Efficacy
4. SUBMACULAR SURGERY
4.1. Surgical Technique
4.2. Complications
4.3. Clinical Efficacy
5. MACULAR TRANSLOCATION
5.1. Treatment Rationale
5.2. Classification
5.2.1. Full Macular Translocation
5.2.2. Limited Macular Translocation
5.3. Preoperative Considerations
5.3.1. Visual Potential, Duration of Pathology and Functional Status of Retina
5.3.2. Likelihood of Achieving Effective Macular Translocation
5.4. Surgical Technique
5.4.1. Full Macular Translocation
5.4.2. Limited Macular Translocation
5.5. Complications
5.6. Clinical Outcomes
6. RPE TRANSPLANTATION AND MACULAR RECONSTRUCTION
6.1. Therapeutic Rationale
6.2. Sources of RPE Cells
6.3. Enhancement of RPE Cell Attachment
6.4. Surgical Technique
6.5. Clinical Outcomes
6.6. Future Trends in RPE Transplantation
7. EPIRETINAL BRACHYTHERAPY
7.1. Rationale for Treatment
7.2. Epimacular Brachytherapy Devices and Efficacy
7.3. Future Trends in Epiretinal Brachytherapy
8. RETINAL PROSTHESIS
9. CONCLUSION
CHAPTER 75:
Surgery for Retinal Vein Occlusions
1. INTRODUCTION
2. ANATOMICAL CONSIDERATIONS
3. CAUSES OF VISUAL LOSS IN PATIENTS WITH VEIN OCCLUSION
4. USE OF INTRAVITREAL STEROIDS AND ANTIVEGFS
5. SURGERY IN RETINAL VEIN OCCLUSIONS
5.1. Rationale behind Surgeries for Retinal Vascular Occlusions
5.2. Surgeries for Vein Occlusion
5.2.1. Vitrectomy and Membrane Peeling
5.2.2. Presence of Macular Edema
5.2.3. Photocoagulation
5.2.4. Closure
5.3. Additional Procedures
5.3.1. Radial Optic Neurotomy
5.3.2. Arteriovenous Sheathotomy
5.3.3. Laser Chorioretinal Anastomoses
5.3.4. Vein Cannulation with t-PA Injection
6. SUMMARY
CHAPTER 76:
Endoscopic Vitreoretinal Surgery
1. INTRODUCTION
2. APPLICATIONS
3. INSTRUMENTATION
4. SURGICAL TECHNIQUE16
4.1. Examination Technique and Training
5. CONCLUSION
CHAPTER 77:
Enzymatic Vitreolysis
1. BACKGROUND
2. VITREOUS ANATOMY AND MOLECULAR STRUCTURE
3. PLASMIN-INDUCED VITREOLYSIS
3.1. Preparation of Plasmin
3.2. Office-based Enzymatic Vitreolysis
3.3. Enzyme-assisted Vitrectomy
4. FUTURE DIRECTIONS
5. CONCLUSION
SECTION 16: LEARNING AND TEACHING
CHAPTER 78:
Vitreoretinal Surgical Training—Role of the Eyesi Simulator
1. INTRODUCTION
2. LEARNING THEORY
3. VIRTUAL REALITY SIMULATORS
3.1. The Eyesi Simulator Vitreoretinal Module
3.1.1. Viewing System
3.1.2. Microsurgical Instruments
3.1.3. Software Features
3.2. Eyesi Anterior Segment
3.3. Eyesi Indirect Ophthalmoscopy
4. RESULTS
5. CONCLUSION
CHAPTER 79:
Recording Surgical Videos, Film Making and Dissemination of Skills
1. INTRODUCTION
2. THE EQUIPMENT
2.1. Microscope
2.2. Camera
2.3. Capture Hardware
2.4. Software
2.5. Our System
3. BASICS OF RECORDING
3.1. Focus
3.2. Field of View
3.3. White Balance
3.3.1. Sources of Light Illumination
3.3.2. Technique of Adjusting White Balance
3.4. Black Balance
3.5. Type of Illumination
3.6. Shutter Speed, Exposure, Gain Control
4. SUMMARY
1. INTRODUCTION
2. PERSONAL PREPAREDNESS
3. PRODUCTION PROCESS
3.1. Development
3.2. Pre-production
3.3. Production
3.4. Editing
3.5. Post-production
4. SUMMARY
INDEX
TOC
Index
×
Chapter Notes
Save
Clear
