Vitreo-retinal Surgery (eBook)

Bernd Kirchhof, David Wong (Herausgeber)

eBook Download: PDF

2007 | 2007
XVI, 156 Seiten
Springer Berlin (Verlag)
978-3-540-33670-9 (ISBN)

Infos

Progress in vitreo-retinal surgery is mercurial. Since this series is dedicated to new developments the reader is presented with a motley list of topics. The advancements described here may represent generally accepted progress in the field: New instruments, Macular hole surgery, Tumor biopsy. The text is well-structured text and the book bridges the gap between primary literature and daily practice.

Inhalt

Foreword 6
Preface 7
Contents 8
Contributors 13
Macular Holes 15
1.1 Epidemiology 15
1.2 Pathogenesis 15
1.3 Clinical Staging 16
1.4 Natural History 17
1.5 Risk of Full- Thickness Macular Hole in the Fellow Eye 18
1.6 Symptoms and Signs 18
1.7 Fluorescein Angiography and Fundus Autofluorescence 19
1.8 Optical Coherence Tomography 20
1.9 Surgical Management of Macular Holes 20
1.10 Technique for Conventional Macular Hole Surgery 21
1.11 Tamponade Agents and Postoperative Posturing 22
1.12 Biological Adjuncts to Macular Hole Surgery 23
1.13 Technique for Intraoperative Application of Biological Adjuncts 24
1.14 Inner Limiting Membrane Peeling 24
1.15 Technique for Inner Limiting Membrane Peeling 25
1.16 Vital Staining to Facilitate Inner Limiting Membrane Peeling 25
1.17 Indocyanine Green 25
1.18 Trypan Blue 26
1.19 Technique for Inner Limiting Membrane Staining 27
1.20 Complications of Macular Hole Surgery 27
1.21 Prognosis Following Macular Hole Surgery 27
References 28
Heavy Silicone Oil for Persistent Macular Holes 33
2.1. Introduction 33
2.1.1 Basics 33
2.1.2 Therapeutic Options 33
2.1.2.1 Observation 34
2.1.2.2 Laser Photocoagulation and Outpatient FGEX 34
2.1.2.3 Re- Operations 34
2.1.2.3.1 New Vitrectomy Using FGEX and 1,330 ng of Transforming Growth Factor- Beta2 34
2.1.2.3.2 New Vitrectomy Performing Indocyanine Green- Assisted ILM Peeling and Autologous Platelets Concentrate Application 34
2.1.2.3.3 New Vitrectomy Using Silicone Oil as Long- Term Endotamponade 34
2.1.2.3.4 New Vitrectomy Using F6H8 34
2.1.2.3.5 New Vitrectomy and Endotamponading with HSO ( Oxane HD) 35
2.1.3 Rationale of HSO Endotamponading 36
2.2 Treatment of Persistent Macular Holes 36
2.3 Conclusions 39
References 44
The Role of Combined Adjunctive 5- Fluorouracil and Low Molecular Weight Heparin in Proliferative Vitreoretinopathy Prevention 46
Core Messages 46
3.1 Introduction 46
3.2 PVR Pathobiology 47
3.3 Adjunctive Agents 47
3.3.1 5- Fluorouracil 47
3.3.2 Low Molecular Weight Heparin 48
3.3.3 Initial Clinical Studies 48
3.4 Clinical Trials of Combined Adjunctive 5FU and LMWH 48
3.4.1 Adjunctive Regime 48
3.4.2 High- Risk Retinal Detachments in Eyes Undergoing Vitrectomy and Gas Exchange ( PVR 1) 49
3.4.3 Established PVR in Eyes Undergoing Vitrectomy and Silicone Oil Exchange ( PVR 2) 49
3.4.4 Unselected Primary Retinal Detachments in Eyes Undergoing Vitrectomy and Gas Exchange ( PVR 3) 49
3.4.5 Macular Translocation with 360° Retinotomy 50
3.5 Implications for Clinical Use 50
3.5.1 Uncomplicated Primary Retinal Detachments 48
3.5.2 Established PVR 50
3.5.3 High- Risk Retinal Detachments 50
3.5.4 Intraocular Trauma Patients Undergoing Vitrectomy Surgery 50
References 51
Slippage of the Retina: What Causes It and How Can It Be Prevented? 53
Core Messages 53
4.1 Introduction 53
4.2 What is Slippage? 53
4.2.1 Surface Tension and Interfacial Tension 53
4.2.2 Shape of Endotamponade Bubble 54
4.2.3 Surface Property of the Retina 55
4.2.4 Fluid– Air Exchange 55
4.3 Setting the Scene for Slippage 56
4.3.1 Perfluorocarbon Liquids and the “ Doughnut” of Fluid 56
4.3.2 Seeing and Doing 58
4.3.3 Air Versus Silicone Oil Exchange for PFCL 58
4.3.4 Oil on Water? No, Water on Oil! 59
4.4 Overfilling and Complete Elimination of Aqueous 60
4.5 Injection of Silicone Oil 60
Acknowledgements 62
References 62
Complete and Early Vitrectomy for Endophthalmitis ( CEVE) as Today’s Alternative to the Endophthalmitis Vitrectomy Study 64
Core Messages 65
5.1 Introduction and Definitions 65
5.2 Etiology and Classification 67
5.3 Pathophysiology, Organisms, and Diagnostics in Brief 67
5.4 Principles of Therapy 68
5.5 The EVS 68
5.6 Rationale for Performing Complete and Early Vitrectomy for Endophthalmitis 69
5.6.1 Why Perform Vitrectomy? 69
5.6.2 Why Perform Early Vitrectomy? 69
5.6.3 Why Perform Complete Vitrectomy? 70
5.7 Complete and Early Vitrectomy for Endophthalmitis: Surgical Steps 70
5.7.1 Initial Steps 70
5.7.2 Cornea 71
5.7.3 Anterior Chamber 71
5.7.4 Pupil 72
5.7.5 ( Intraocular) Lens 72
5.7.6 Posterior Lens Capsule 72
5.7.7 Vitrectomy 72
5.7.8 When to Stop Vitreous Removal? 74
5.7.9 Retina 74
5.7.10 Enucleation/ Evisceration 75
5.7.11 Pharmacological Treatment 75
5.8 Surgical Decision- Making and Complications 75
5.9 Results with CEVE and Their Comparison with the EVS 77
5.10 Summary and Recommendations 78
References 79
Treatment of Acute Bacterial Endophthalmitis After Cataract Surgery Without Vitrectomy 80
Core Messages 80
6.1 Introduction 81
6.1.1 Basics 81
6.1.2 Pathophysiology 81
6.1.2.1 Phases of Infection 81
6.1.2.1.1 Incubation Phase 82
6.1.2.1.2 Acceleration Phase 82
6.1.2.1.3 Destructive Phase 82
6.1.3 Clinical Diagnosis 82
6.1.3.1 Role of Ultrasonography 83
6.1.4 Microbial Spectrum 83
6.2 Therapeutical Approaches 86
6.2.1 Basics 83
6.2.2 Early Pars Plana Vitrectomy 86
6.2.3 Nonvitrectomizing Endophthalmitis Treatment 87
6.3 Emergency Management of Endophthalmitis After Cataract Surgery 87
6.3.1 Surgical Technique 87
6.3.2 Equipment for the Emergency Management of Endophthalmitis 88
6.3.3 Treatment Protocol 88
6.3.4 Treatment Outcome in Endophthalmitis Without Immediate Vitrectomy 88
6.4 Conclusion 92
Acknowledgements 92
References 92
New Instruments in Vitrectomy 95
Core Messages 95
7.1 Introduction 95
7.2 Sutureless Transconjunctival Vitrectomy 95
7.2.1 25-Gauge Vitrectomy System 95
7.2.2 Instruments 96
7.2.2.1 Trocars 96
7.2.2.2 Vitreous Cutter 96
7.2.2.3 Light Pipe 97
7.2.2.4 Other 25- Gauge Instruments 97
7.2.2.5 Other Instruments 97
7.2.3 Surgical Procedures of the 25- Gauge System 99
7.2.1 25-Gauge Vitrectomy System 99
7.2.3.2 Vitrectomy 99
7.2.3.3 Closure of the Wound 99
7.2.4 Advantage and Disadvantage of 25- Gauge System 99
7.3 23- Gauge Vitrectomy System 100
7.4 Xenon Endo- Illumination for Vitrectomy 100
References 106
25- Gauge Biopsy of Uveal Tumors 109
Core Messages 109
8.1 Introduction 109
8.2 Diagnosis of Choroidal Tumors 109
8.3 Current Biopsy Techniques 112
8.3.1 Fine Needle Aspiration Biopsy 112
8.3.2 Trans- Scleral Tumor Biopsy 112
8.3.3 20- Gauge Vitreous Cutter 112
8.3.4 Trans-Vitreal Incisional Biopsy 112
8.3.5 25- Gauge Biopsy Technique 114
8.4 Preoperative Management 114
8.5 Surgical Technique 114
8.6 Care of Specimen 114
8.7 Postoperative Management 114
8.8.1 Adequacy of Sample 115
8.8.2 Sampling Error 115
8.8.3 Tumor Seeding 115
8.8.4 Hemorrhage 115
8.8.5 Rhegmatogenous Retinal Detachment 119
8.8.6 Other Complications 119
8.8 Results and Complications 115
8.9 Indications and Contraindications 119
8.10 Conclusions 123
References 123
Vitrectomy Against Floaters 125
9.1 Introduction 125
9.2 Clinical Findings 126
9.3 Symptoms and Natural Course 126
9.4 Diagnostic Methods 127
9.5 Surgical Treatment for Vitreous Floaters: Important Studies 127
9.6 Vitrectomy for Vitreous Floaters Despite Full Visual Acuity 127
9.6.1 Patients 128
9.6.2 Surgical Technique 128
9.6.3 Results 129
9.6.4 Case Report 129
9.7 Analysis of Clinical Studies 129
9.8 Alternative Therapeutic Options 130
9.9 Personality Traits 131
9.10 Alternative Assessment of Visual Function 131
9.11 Conclusions References 133
Treatment of Retinal Detachment from Inferior Breaks with Pars Plana Vitrectomy 135
10.1 Introduction 135
10.2 Management of InferiorBreaks with PPV:Recent Publications 137
10.3 PPV Alone with Air Tamponade: Surgical Technique 139
References 141
Subclinical Retinal Detachment 143
Core Messages 143
11.1 Definition 143
11.2 Natural History 145
11.2.1 Role of the Vitreous 145
11.3 Therapeutic Options 146
11.3.1 Observation 146
11.3.2 Laser Demarcation 147
11.3.3 Surgery 147
11.3.3.1 Pneumatic Retinopexy 147
11.3.3.2 Scleral Buckling 148
11.3.3.3 Pars Plana Vitrectomy 148
11.3.4 Pros and Cons of Treating 148
11.3.4.1 Pros of Treating 148
11.3.4.2 Cons of Treating 148
11.4 Current Clinical Practice/ Recommendations 149
11.5 Subclinical Retinal Detachment Diagnosed with Optical Coherence Tomography After Successful Surgery for Rhegmatogenous Retinal Detachment 149
References 150
Autologous Translocation of the Choroid and RPE in Patients with Geographic Atrophy 153
12.1 Introduction: Pathologyand Epidemiology 153
12.2 Treatment Approaches in Patients with Geographic Atrophy 154
12.3 Concept of Translocation of a Free Choroidal: RPE Graft ( Free Graft Translocation) 154
12.3.1 Patients and Methods 154
12.3.2 Free Graft Translocation Surgery in Dry AMD 155
12.3.3 Results 155
12.4 Comment 158
Acknowledgements 161
References 161
Subject Index 163

Produkt-Details

• Erscheint lt. Verlag: 20.1.2007
• Reihe/Serie: Essentials in Ophthalmology
• Reihe/Serie: Essentials in Ophthalmology
• Zusatzinfo: XVI, 156 p.
• Verlagsort: Berlin
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete
• Schlagworte: Cataract Surgery • macular degeneration • retina • Surgery • Tumor
• ISBN-10: 3-540-33670-2 / 3540336702
• ISBN-13: 978-3-540-33670-9 / 9783540336709