Step By Step Vitrectomy

Step By Step Vitrectomy

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Product Details

ISBN-13: 9789350903544
Publisher: Jp Medical Pub
Publication date: 05/30/2013
Pages: 376
Product dimensions: 6.30(w) x 9.30(h) x 0.80(d)

Table of Contents

1 Surgical Anatomy Cristian Fernández-Martinez José Juan Martinez-Toldos 1

Introduction 1

Anatomy of the Vitreous 1

Vitreous Base and Vitreoretinal Interface 2

Anatomical Distances in Vitrectomy 4

Crystalline Lens 4

Extraocular Muscles 4

Ciliary Body 5

Blood Vessels 5

2 Presurgery Examination Manolo Baeza Diaz José Juan Martinez-Toldos 9

Medical History 9

Visual Acuity 9

Pupil Reflexes 9

Color Perception 10

Vascular Entoptic Test 10

Slit Lamp Microscopy 10

Tonometry 10

Examining the Fundus 11

Indirect Ophthalmoscopy 11

Biomicroscopy of the Retina 11

Ultrasonography 11

Vitreous Disorder 12

Fluorescein Angiography 16

Electrophysiology 17

Electroretinography 17

Evoked Visual Potentials 17

3 Vitrectomy and Optical Coherence Tomography David Salom Patricia Udaondo Manuel Díaz Llopis José Juan Martínez-Toldos 19

Introduction 19

Optical Coherence Tomography in Macular Holes 20

Optical Coherence Tomography in Epiretinal Membranes 21

Optical Coherence Tomography in Vitreoretinal Traction Syndrome 22

Intraoperative 25

4 Anesthesia Manuel Baeza José Juan Martínez-Toldos 28

Introduction 28

Types of Anesthesia 29

General Anesthesia 29

Local Anesthesia 30

Retrobulbar Block 33

Peribulbar Anesthesia 35

Sub-Tenon's Anesthesia 36

5 Instrumentation José Juan Martínez-Toldos Cristian Fernández-Martínez 43

Operating Room 43

Introduction 43

Requirements 43

Ophthalmologic Surgery Table 43

Instrument Column 45

Integrated Vitrectomy Systems 45

Image Recorder 45

Operating Microscope 46

Visualization Systems 49

Introduction 49

Upright Image Contact Lenses 50

Landers Biconcave Lens 50

Machemer Magnifying Lens 51

Peyman Wide-angle Lens 52

Machemer Plano-concave Lens 52

Tolentino Twenty Degree Prism Lens 52

Tolentino Thirty Degree Prism Lens 52

Woldoff Biconcave Prism Lens 52

Wide-Angle-Viewing Systems 52

Use of the Erect Indirect Binocular Ophthalmic System 56

Other Visualization Systems 58

Combined Procedures 61

Endoillumination 65

Introduction 65

External Systems 65

Internal Systems 65

Chandelier System 67

Infusion Pressure 71

Introduction 71

Hydrostatic Pressure 71

Infusion Pump or Gas Forced Infusion 72

Pressure Control 75

Low Intraocular Pressure 75

High Intraocular Pressure 75

Infusion Devices 76

Twenty-Gauge Incisions 76

Opening the Conjunctiva 76

Twenty-Gauge Transconjunctival Vitrectomy 78

Suction and Cutter Systems 79

Introduction 79

Active Aspiration 79

Passive Aspiration 83

Vitrectomy Probes 84

Constellation Vision System 85

Stellaris PC Vision Enhancement System 88

Diathermy 90

Introduction 90

Retinopexy 93

Introduction 93

Laser Endophotocoagulation 93

Argon Laser 96

Diode Laser (810 nm) 96

Green Diode Laser (532 nm) 96

Yellow Laser (577 nm) 97

Phacoemulsification 99

Introduction 99

Ultrasonic Fragmentation 102

Introduction 102

Forceps and Scissors 104

Introduction 104

Vitreous Substitutes: Manipulators 109

Introduction 109

Hyaluronic Acid 109

Perfluorocarbon Liquids 109

Vitreous Substitutes: Tamponades 113

Introduction 113

Intraocular Gases 113

Silicone Oil 115

Silicone Solvent 116

Heavy Silicone Oil 117

Densiron 119

6 Basic Vitrectomy Cristian Fernández-Martínez José Juan Martínez-Toldos 121

Check List 121

Positioning the Patient 122

Visualization Systems 122

Contact Systems 122

Noncontact Systems 122

Conjunctival Incisions 123

Sclerotomy 124

Pupil Management 127

Phacoemulsification 128

Surgical Technique 128

Special Cases 129

Removing The Vitreous Humor: Basic Concepts 129

Aspiration Systems 131

Active Aspiration 131

Passive Aspiration 132

Peeling Membranes in Vitrectomy 132

Segmenting Membranes 134

Delaminating Membranes 135

Staining Membranes 136

Perfluorocarbon Liquids 140

Uses of Perfluorocarbon Liquids 141

Intraoperative Management of Perfluorocarbon Liquids 142

Potential Problems during the Use of Perfluorocarbon 146

Fluid-Air Exchange 146

Use of Gas in Vitrectomy 147

Nonexpanding Gas 147

Expanding Gas 148

Clinical Indications of Gases 148

Air-Gas Exchange 148

Postoperative Management of Patients Receiving Intraocular Gas 149

Silicone Oil in Vitrectomy 149

Injection of Silicone Oil 149

Emulsification of the Silicone Oil 150

Indications of Silicone Oil Tamponade 150

Inferior Peripheral Iridectomy 151

Removal of Silicone Oil 151

Closure After Surgery 152

7 Pars Plana Lensectomy Carlos Mateo Anniken Burés 156

Introduction 156

Surgical Technique 156

Advantages of Pars Plana Lensectomy 158

Pars Plana Lensectomy Indications 159

Vitreoretinal Proliferation 159

Perforating Ocular Trauma with or without Intraocular Foreign Body 160

Proliferative Diabetic Retinopathy 162

8 Basic Endoscopic Vitrectomy Vicente J Chaqués-Alepuz Enrique V López-Sánchez 164

Basic Equipment for Endoscopy 164

Technical Aspects: Visualization 166

Image Rotation 167

Image Artifacts 168

Technical Tips for the Beginners 169

Endoscopic Posterior Vitrectomy: Basic Concepts and Indications 170

Surgeon's Position 170

Image Size and Lighting 171

Blurred Image 171

Complications of Vitreoretinal Surgery that can be Avoided by Endoscopy 171

Vitreous Incarceration 171

Controlling Intraoperative Bleeding 172

Techniques and Maneuvers of Vitrectomy and Endoscopy 173

Vitrectomy 173

Membranectomy 174

Fluid-Air Exchange 174

Endophotocoagulation 174

Pars Plana Lensectomy 175

Capsulectomy 175

Introducing Silicone Oil 175

Introducing Perfluorocarbon Liquid 176

Diabetic Retinopathy and Endoscopic Vitrectomy 176

Vitreous Hemorrhage 177

Neovascularization of the Iris with Opacity of the Media 177

Retinal Detachment Surgery 177

Proliferative Vitreoretinopathy 178

Endoscopic Vitrectomy for Crystalline Lens Fragments Luxated in the Vitreous Cavity 180

Endoscopic Vitrectomy in Endophthalmitis 181

9 Minimal Incision Vitrectomy Surgery: Twenty-Three, Twenty-Five and Twenty-Seven Gauge José Juan Martínez-Toldos Javier A. Montero-Moreno José M Ruiz-Moreno Félix Armadá-Maresca Natalia Pastora-Salvador Anna Grabowoska María Granados-Fernandez Beatriz Manzano Muñoz 184

Twenty-Three Gauge Vitrectomy 184

Introduction 184

Incision Construction 185

Vitrectomy 186

Closing the Incision 187

Benefits of Twenty-Three Gauge Surgery 187

Complications 187

Twenty-Five Gauge Vitrectomy 189

Introduction 189

Benefits of Microincision Vitrectomy 192

Drawbacks of Microincision Vitrectomy 192

Complications 192

Future Perspectives 193

Twenty-Seven Gauge 196

Introduction 196

Instrumentation 196

Indications 199

10 Vitrectomy in Anterior Segment Surgery Complications José Juan Martínez-Toldos Juan Carlos Elvira-Cruañes 202

Introduction 202

Ocular Perforation in Retrobulbar Anesthesia 202

Transconjunctival Sub-Tenon's Anesthesia 203

Ocular Perforation 203

Treatment 204

Retrobulbar Hemorrhage 205

Anterior Vitrectomy 205

Vitrectomy following Vitreous Loss 206

Retained Lens Fragments 209

Surgical Indications 211

Associating Surgery at the Time of Lens Dislocation 211

Surgical Technique 212

Intraocular Lens Dislocation 216

Surgical Technique 219

Late Intraocular Lens Dislocation with the Capsular Bag 222

Mechanisms 223

Prevention 223

Treatment 224

Endophthalmitis 225

Etiology 226

Treatment 227

Vitrectomy 228

Late-Onset Endophthalmitis 229

11 Eye Trauma Vitrectomy Joséfina Bañuelos Banuelos Patricia Martínez-García Javier Orduña-Azcona Ana Orive-Bañuelos 235

Introduction 235

Vitrectomy in Open Traumatisms 235

Clinical History and Initial Examination 235

Presurgical Considerations 236

Surgical Technique 237

Special Situations 240

Trauma and Dense Vitreous Hemorrhage 240

Trauma and Retinal Detachment 241

Trauma and Intraocular Foreign Body 241

Trauma and Endophthalmitis 244

Vitrectomy and Compliactions of the Ocular Trauma 246

Macular Hole 246

Ocular Hypotony and Bulb Phthisis 247

12 Basic Vitrectomy in Diabetic Retinopathy Jose Garcia-Arumi Anna Boixadera Laura Distefano Vicente Martínez-Castillo Miguel Angel Zapata 250

Introduction 250

Surgical Approach 251

Vitrectomy for Diabetic Macular Edema 257

13 Macular Surgery Amparo Navea Elena Palacios Carmen Desco Jorge Mataix 261

Surgery on the Surface of the Macula 261

Preliminary Considerations 261

Interview with the Patient 262

Surgery Preparation 263

Technical Requirements 263

Human Requirements 263

Patient Preparation 263

Surgeon Preparation 263

Vitrectomy 264

Specific Technical Points in Macular Hole 265

Surgery in the Subretinal Macular Space 267

Severe Submacular Hemorrhage Located into the Macular Area 267

Masive Subretinal Hemorrhage that also Affects the Macula 269

Subfoveal Perfluorocarbon Bubbles 270

14 Vitrectomy for Retinal Detachment with and without Proliferative Vitreoretinipathy J Fernando Arevalo Reinaldo A Garcia Veronica Oria 272

Introduction 272

Combined Vitrectomy and Scleral Buckling 273

Scleral Buckling Technique 273

Encircling Exoplants 275

Scleral Suture Technique 277

Primary Vitrectomy 277

Basic Operative Steps in Primary Vitrectomy 277

Intraocular Tamponade 283

Small-Gauge Pars Plana Vitrectomy 283

Sclerotomies with 23-Gauge Vitrectomy 284

Sclerotomies with 25-Gauge Vitrectomy 284

New Considerations in Fluid Dynamics During Small-Gauge Vitrectomy 285

Increasing Safety 286

Wound Closure 286

Retinal Tears 287

Hypotony 288

Endophthalmitis 288

Vitrectomy for Retinal Detachment with Proliferative Vitreoretinopathy 288

Risk Factors for the Development of Proliferative Vitreoretinopathy 289

Diagnosis of Proliferative Vitreoretinopathy 290

Classification of Proliferative Vitreoretinopathy 290

Type 1 291

Type 2 293

Type 3 293

Type 4 293

Type 5 295

Surgery for Proliferative Vitreoretinopathy 295

Timing of Surgery 295

Scleral Buckling in Proliferative Vitreoretinopathy 296

Lensectomy and Intraocular Lens 296

Vitrectomy for Proliferative Vitreoretinopathy 297

Removal of Posterior Epiretinal Proliferation 298

Removal of Anterior Epiretinal Proliferation 298

Removal of Subretinal Proliferation 298

Relaxing Retinotomies and Retinectomies 299

Creating a Chorioretinal Adhesion 302

Intraocular Tamponade 302

Removal of Silicone Oil 303

Reoperations for Recurrent Retinal Detachment from Proliferative Vitreoretinopathy 304

Adjunctive Treatment in Proliferative Vitreoretinopathy 304

Giant Retinal Tears 305

Postoperative Complications 306

Summary 306

15 Current Indications of Antiangiogenics in Vitrectomy Mauricio Maia Fernando M Penha J Fernando Arevalo 313

Antiangiogenics: Overview 313

Introduction: Vascular Endothelium Growth Factor 313

Role of Bevacizumab and Ranibizumab in the Angiogenesis Process 313

Intraoperative Bleeding During Pars Plana Vitrectomy In Proliferative Diabetic Retinopathy 315

Introduction 315

Vitreoretinal Bleeding 315

Preoperative Procedures to Minimize the Possibility of Intraoperative bLeeding 316

Blood Pressure Control 316

Antiplatelet and Anticoagulants-Is it Necessary to Discontinue Them before Surgery? 316

Intravitreal Injection of Anti-VEGF Inhibitors in Proliferative Diabetic Retinopathy 317

Intravitreal Injection of Anti-Vegf Before Surgery in Proliferative Diabetic Retinopathy 317

Rationale 317

Intravitreal Bevacizumab Before Pars Plana Vitrectomy in Proliferative Diabetic Retinopathy 317

Intravitreal Ranibizumab before Pars Plana Vitrectomy in Proliferative Diabetic Retinopathy 319

Technique of Preoperative Intravitreal Anti-VEGF Injection 319

Care During Preoperative Intravitreal Anti-VEGF Injection Before Pars Plana Vitrectomy in Proliferative Diabetic Retinopathy 320

Conclusion of Intravitreal Injection of Anti-VEGF Before Proliferative Diabetic Retinopathy 320

Techniques of Intraoperative Posterior Segment Bleeding Control 320

Rising the Intraocular Pressure 321

Fluid-Air Exchange 322

Perfluorocarbon Liquids 323

Endodiathermy and Cauterization 323

Laser Photocoagulation 325

Combination of Techniques 326

16 Use of Sustained Drug Release Implants in Vitrectomized Eyes Jose Maria Ruiz-Moreno Javier A Montero 331

Introduction 331

Clinical Case 334

17 Enzymatic Vitrectomy Patricia Udaondo David Salom Salvador Garcia-Delpech Manuel Díaz-Llopis 337

Introduction 337

Concept of Enzymatic Vitrectomy 339

Methods and Mechanism of Action 339

18 Posterior Vitrectomy Complications Carme Guardia Jaume Catalá Jairo Hoyos-Chacón 343

Introduction 343

Intraoperative Complications 343

Sclerotomy Complications 343

Visualization Problems 346

Retinal Tears 352

Retinopexy Complications 354

Postoperative Complications 354

Corneal Complications 354

Ocular Hypertension and Glaucoma 355

Vitreous Hemorrhage 357

Retinal Detachment 358

Proliferative Vitreoretinopathy 359

Intraocular Inflammation and Fibrinoid Reaction 360

Tamponade and Manipulator Agents Complications 360

Endophthalmitis 364

Cataract 364

To Prevent Vitroretinal Surgery Complications 365

Index 369

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