Kirchhof / Wong Vitreo-retinal Surgery

1. Auflage 2007
ISBN: 978-3-540-33670-9
Verlag: Springer Berlin Heidelberg
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 156 Seiten

Reihe: Essentials in Ophthalmology

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. New ideas are set out to be tested for their benefit, for example: AMD surgery, Adjunctive pharmacotherapy. Reflections on incessant clinical problems in vitreo-retina surgery require superior scrutinization of established surgical techniques and indications: Posterior slippage, Inferior breaks, Subclinical retinal detachments. The editors will expand this list in future editions with topics like: new support for buckling surgery, enzyme assisted vitrectomy, new tamponades and other yet unknown fields of progress.

Autoren/Hrsg.

Kirchhof, Bernd

Wong, David

Inhaltsverzeichnis

1;Foreword;6
2;Preface;7
3;Contents;8
4;Contributors;13
5;Macular Holes;15
5.1;1.1 Epidemiology;15
5.2;1.2 Pathogenesis;15
5.3;1.3 Clinical Staging;16
5.4;1.4 Natural History;17
5.5;1.5 Risk of Full- Thickness Macular Hole in the Fellow Eye;18
5.6;1.6 Symptoms and Signs;18
5.7;1.7 Fluorescein Angiography and Fundus Autofluorescence;19
5.8;1.8 Optical Coherence Tomography;20
5.9;1.9 Surgical Management of Macular Holes;20
5.10;1.10 Technique for Conventional Macular Hole Surgery;21
5.11;1.11 Tamponade Agents and Postoperative Posturing;22
5.12;1.12 Biological Adjuncts to Macular Hole Surgery;23
5.13;1.13 Technique for Intraoperative Application of Biological Adjuncts;24
5.14;1.14 Inner Limiting Membrane Peeling;24
5.15;1.15 Technique for Inner Limiting Membrane Peeling;25
5.16;1.16 Vital Staining to Facilitate Inner Limiting Membrane Peeling;25
5.17;1.17 Indocyanine Green;25
5.18;1.18 Trypan Blue;26
5.19;1.19 Technique for Inner Limiting Membrane Staining;27
5.20;1.20 Complications of Macular Hole Surgery;27
5.21;1.21 Prognosis Following Macular Hole Surgery;27
5.22;References;28
6;Heavy Silicone Oil for Persistent Macular Holes;33
6.1;2.1. Introduction;33
6.1.1;2.1.1 Basics;33
6.1.2;2.1.2 Therapeutic Options;33
6.1.2.1;2.1.2.1 Observation;34
6.1.2.2;2.1.2.2 Laser Photocoagulation and Outpatient FGEX;34
6.1.2.3;2.1.2.3 Re- Operations;34
6.1.2.3.1;2.1.2.3.1 New Vitrectomy Using FGEX and 1,330 ng of Transforming Growth Factor- Beta2;34
6.1.2.3.2;2.1.2.3.2 New Vitrectomy Performing Indocyanine Green- Assisted ILM Peeling and Autologous Platelets Concentrate Application;34
6.1.2.3.3;2.1.2.3.3 New Vitrectomy Using Silicone Oil as Long- Term Endotamponade;34
6.1.2.3.4;2.1.2.3.4 New Vitrectomy Using F6H8;34
6.1.2.3.5;2.1.2.3.5 New Vitrectomy and Endotamponading with HSO ( Oxane HD);35
6.1.3;2.1.3 Rationale of HSO Endotamponading;36
6.2;2.2 Treatment of Persistent Macular Holes;36
6.3;2.3 Conclusions;39
6.4;References;44
7;The Role of Combined Adjunctive 5- Fluorouracil and Low Molecular Weight Heparin in Proliferative Vitreoretinopathy Prevention;46
7.1;Core Messages;46
7.2;3.1 Introduction;46
7.3;3.2 PVR Pathobiology ;47
7.4;3.3 Adjunctive Agents;47
7.4.1;3.3.1 5- Fluorouracil;47
7.4.2;3.3.2 Low Molecular Weight Heparin;48
7.4.3;3.3.3 Initial Clinical Studies;48
7.5;3.4 Clinical Trials of Combined Adjunctive 5FU and LMWH;48
7.5.1;3.4.1 Adjunctive Regime;48
7.5.2;3.4.2 High- Risk Retinal Detachments in Eyes Undergoing Vitrectomy and Gas Exchange ( PVR 1);49
7.5.3;3.4.3 Established PVR in Eyes Undergoing Vitrectomy and Silicone Oil Exchange ( PVR 2);49
7.5.4;3.4.4 Unselected Primary Retinal Detachments in Eyes Undergoing Vitrectomy and Gas Exchange ( PVR 3);49
7.5.5;3.4.5 Macular Translocation with 360° Retinotomy;50
7.6;3.5 Implications for Clinical Use ;50
7.6.1;3.5.1 Uncomplicated Primary Retinal Detachments;48
7.6.2;3.5.2 Established PVR;50
7.6.3;3.5.3 High- Risk Retinal Detachments;50
7.6.4;3.5.4 Intraocular Trauma Patients Undergoing Vitrectomy Surgery;50
7.7;References;51
8;Slippage of the Retina: What Causes It and How Can It Be Prevented?;53
8.1;Core Messages;53
8.2;4.1 Introduction;53
8.3;4.2 What is Slippage?;53
8.3.1;4.2.1 Surface Tension and Interfacial Tension;53
8.3.2;4.2.2 Shape of Endotamponade Bubble;54
8.3.3;4.2.3 Surface Property of the Retina;55
8.3.4;4.2.4 Fluid– Air Exchange;55
8.4;4.3 Setting the Scene for Slippage;56
8.4.1;4.3.1 Perfluorocarbon Liquids and the “ Doughnut” of Fluid;56
8.4.2;4.3.2 Seeing and Doing;58
8.4.3;4.3.3 Air Versus Silicone Oil Exchange for PFCL;58
8.4.4;4.3.4 Oil on Water? No, Water on Oil!;59
8.5;4.4 Overfilling and Complete Elimination of Aqueous;60
8.6;4.5 Injection of Silicone Oil;60
8.7;Acknowledgements;62
8.8;References;62
9;Complete and Early Vitrectomy for Endophthalmitis ( CEVE) as Today’s Alternative to the Endophthalmitis Vitrectomy Study;64
9.1;Core Messages;65
9.2;5.1 Introduction and Definitions;65
9.3;5.2 Etiology and Classification;67
9.4;5.3 Pathophysiology, Organisms, and Diagnostics in Brief;67
9.5;5.4 Principles of Therapy;68
9.6;5.5 The EVS ;68
9.7;5.6 Rationale for Performing Complete and Early Vitrectomy for Endophthalmitis;69
9.7.1;5.6.1 Why Perform Vitrectomy?;69
9.7.2;5.6.2 Why Perform Early Vitrectomy?;69
9.7.3;5.6.3 Why Perform Complete Vitrectomy?;70
9.8;5.7 Complete and Early Vitrectomy for Endophthalmitis: Surgical Steps;70
9.8.1;5.7.1 Initial Steps;70
9.8.2;5.7.2 Cornea;71
9.8.3;5.7.3 Anterior Chamber;71
9.8.4;5.7.4 Pupil;72
9.8.5;5.7.5 ( Intraocular) Lens;72
9.8.6;5.7.6 Posterior Lens Capsule;72
9.8.7;5.7.7 Vitrectomy;72
9.8.8;5.7.8 When to Stop Vitreous Removal?;74
9.8.9;5.7.9 Retina;74
9.8.10;5.7.10 Enucleation/ Evisceration;75
9.8.11;5.7.11 Pharmacological Treatment;75
9.9;5.8 Surgical Decision- Making and Complications;75
9.10;5.9 Results with CEVE and Their Comparison with the EVS;77
9.11;5.10 Summary and Recommendations;78
9.12;References;79
10;Treatment of Acute Bacterial Endophthalmitis After Cataract Surgery Without Vitrectomy;80
10.1;Core Messages;80
10.2;6.1 Introduction;81
10.2.1;6.1.1 Basics;81
10.2.2;6.1.2 Pathophysiology;81
10.2.2.1;6.1.2.1 Phases of Infection;81
10.2.2.2;6.1.2.1.1 Incubation Phase;82
10.2.2.3;6.1.2.1.2 Acceleration Phase;82
10.2.2.4;6.1.2.1.3 Destructive Phase;82
10.2.3;6.1.3 Clinical Diagnosis;82
10.2.3.1;6.1.3.1 Role of Ultrasonography;83
10.2.4;6.1.4 Microbial Spectrum;83
10.3;6.2 Therapeutical Approaches ;86
10.3.1;6.2.1 Basics;83
10.3.2;6.2.2 Early Pars Plana Vitrectomy;86
10.3.3;6.2.3 Nonvitrectomizing Endophthalmitis Treatment;87
10.4;6.3 Emergency Management of Endophthalmitis After Cataract Surgery ;87
10.4.1;6.3.1 Surgical Technique;87
10.4.2;6.3.2 Equipment for the Emergency Management of Endophthalmitis;88
10.4.3;6.3.3 Treatment Protocol;88
10.4.4;6.3.4 Treatment Outcome in Endophthalmitis Without Immediate Vitrectomy;88
10.5;6.4 Conclusion;92
10.6;Acknowledgements;92
10.7;References;92
11;New Instruments in Vitrectomy;95
11.1;Core Messages;95
11.2;7.1 Introduction;95
11.3;7.2 Sutureless Transconjunctival Vitrectomy ;95
11.3.1;7.2.1 25-Gauge Vitrectomy System;95
11.3.2;7.2.2 Instruments;96
11.3.2.1;7.2.2.1 Trocars;96
11.3.2.2;7.2.2.2 Vitreous Cutter;96
11.3.2.3;7.2.2.3 Light Pipe;97
11.3.2.4;7.2.2.4 Other 25- Gauge Instruments;97
11.3.2.5;7.2.2.5 Other Instruments;97
11.3.3;7.2.3 Surgical Procedures of the 25- Gauge System ;99
11.3.3.1;7.2.1 25-Gauge Vitrectomy System;99
11.3.3.2;7.2.3.2 Vitrectomy;99
11.3.3.3;7.2.3.3 Closure of the Wound;99
11.3.4;7.2.4 Advantage and Disadvantage of 25- Gauge System;99
11.4;7.3 23- Gauge Vitrectomy System;100
11.5;7.4 Xenon Endo- Illumination for Vitrectomy;100
11.6;References;106
12;25- Gauge Biopsy of Uveal Tumors;109
12.1;Core Messages;109
12.2;8.1 Introduction;109
12.3;8.2 Diagnosis of Choroidal Tumors ;109
12.4;8.3 Current Biopsy Techniques ;112
12.4.1;8.3.1 Fine Needle Aspiration Biopsy;112
12.4.2;8.3.2 Trans- Scleral Tumor Biopsy;112
12.4.3;8.3.3 20- Gauge Vitreous Cutter;112
12.4.4;8.3.4 Trans-Vitreal Incisional Biopsy;112
12.4.5;8.3.5 25- Gauge Biopsy Technique;114
12.5;8.4 Preoperative Management;114
12.6;8.5 Surgical Technique;114
12.7;8.6 Care of Specimen;114
12.8;8.7 Postoperative Management;114
12.8.1;8.8.1 Adequacy of Sample;115
12.8.2;8.8.2 Sampling Error;115
12.8.3;8.8.3 Tumor Seeding;115
12.8.4;8.8.4 Hemorrhage;115
12.8.5;8.8.5 Rhegmatogenous Retinal Detachment;119
12.8.6;8.8.6 Other Complications;119
12.9;8.8 Results and Complications ;115
12.10;8.9 Indications and Contraindications ;119
12.11;8.10 Conclusions;123
12.12;References;123
13;Vitrectomy Against Floaters;125
13.1;9.1 Introduction;125
13.2;9.2 Clinical Findings;126
13.3;9.3 Symptoms and Natural Course;126
13.4;9.4 Diagnostic Methods;127
13.5;9.5 Surgical Treatment for Vitreous Floaters: Important Studies;127
13.6;9.6 Vitrectomy for Vitreous Floaters Despite Full Visual Acuity;127
13.6.1;9.6.1 Patients;128
13.6.2;9.6.2 Surgical Technique;128
13.6.3;9.6.3 Results;129
13.6.4;9.6.4 Case Report;129
13.7;9.7 Analysis of Clinical Studies;129
13.8;9.8 Alternative Therapeutic Options;130
13.9;9.9 Personality Traits;131
13.10;9.10 Alternative Assessment of Visual Function;131
13.11;9.11 Conclusions References;133
14;Treatment of Retinal Detachment from Inferior Breaks with Pars Plana Vitrectomy;135
14.1;10.1 Introduction;135
14.2;10.2 Management of InferiorBreaks with PPV:Recent Publications;137
14.3;10.3 PPV Alone with Air Tamponade: Surgical Technique;139
14.4;References;141
15;Subclinical Retinal Detachment;143
15.1;Core Messages;143
15.2;11.1 Definition;143
15.3;11.2 Natural History;145
15.4;11.2.1 Role of the Vitreous;145
15.5;11.3 Therapeutic Options ;146
15.5.1;11.3.1 Observation;146
15.5.2;11.3.2 Laser Demarcation;147
15.5.3;11.3.3 Surgery;147
15.5.3.1;11.3.3.1 Pneumatic Retinopexy;147
15.5.3.2;11.3.3.2 Scleral Buckling;148
15.5.3.3;11.3.3.3 Pars Plana Vitrectomy;148
15.5.4;11.3.4 Pros and Cons of Treating ;148
15.5.4.1;11.3.4.1 Pros of Treating;148
15.5.4.2;11.3.4.2 Cons of Treating;148
15.6;11.4 Current Clinical Practice/ Recommendations;149
15.7;11.5 Subclinical Retinal Detachment Diagnosed with Optical Coherence Tomography After Successful Surgery for Rhegmatogenous Retinal Detachment;149
15.8;References;150
16;Autologous Translocation of the Choroid and RPE in Patients with Geographic Atrophy;153
16.1;12.1 Introduction: Pathologyand Epidemiology;153
16.2;12.2 Treatment Approaches in Patients with Geographic Atrophy;154
16.3;12.3 Concept of Translocation of a Free Choroidal: RPE Graft ( Free Graft Translocation);154
16.3.1;12.3.1 Patients and Methods;154
16.3.2;12.3.2 Free Graft Translocation Surgery in Dry AMD;155
16.3.3;12.3.3 Results;155
16.4;12.4 Comment;158
16.5;Acknowledgements;161
16.6;References;161
17;Subject Index;163