ATHANASIOS NIKOLAKOPOULOSTHESSALONIKI-GREECE

anikolako@yahoo.gr

THIRD INTERNATIONAL FORUM OF OPHTHALMIC SURGERY

1. Neovascular tissue is bleeding2. Tractional tears can be away from the working area3. Retina and membranes can be as one tissue4. Mobility of a ”thin”detached retina5. Heavy laser,has prodused atrophic scars that open up

Severe hemorrhagesIatrogenic untreated tearsPostop persistent retinal detachment -neovascular glaucoma

1. Stiffer instruments2. Duty cycle3. Port wider (closer to retina surface)4. IOP control + VGFI5. Controlled vacum6. Higher flow rate7. 5000cpm – less traction8. Control linear reflux (wash out)9. Control linear extrusion10. Simultaneous two step exchange of PFCL - air -

silicone oil 5700cts

4 PORT 25G VITRECTOMY

Always bimanual surgery (25-27 chandelier light) always wide angle observation systems (non contact)

1) Lift, detect and cut (5000cpm, 600 vacum) under visual control (NO SCISSORS). Dissecting in order to have only single traction direction

2) Exchange of fluid – air – 5700cts silicone oil under direct visualization. (air infusion is on 20mmHg and the silicone oil injection on 60psi)

3) Soft tip blood evacuation, IOP controlling hemorrhage4) Curved laser probe to reach the periphery5) Usually no sutures needed at the end

120 cases using 25G single hand vitrectomy without the use of current evolution tecnologies.142 cases using bimanual 25G with the current evolution systems and 5700cts silicone oil injection in the last two years.

RESULTS35% less iatrogenic tears50% better visual outcome after silicone oil removal40% less postop early rebleeding.

1. A new concept for vitreous surgery. 7 . Two instrument techniques in pars plana vitrectomy. Machemer R. Arch Ophthalmol. 1974.

2. Four port bimanual vitrectomy. Gaynon MW, Schepens CL, Hirose T. Arch Ophthalmol. 1986.

3. Temporary Silicone oil tamponade in the treatment of complicated diabetic retinal detachments. Gonvers M. Graefes Arch Clin Exp Ophthalmol. 1990.

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