Ординатура / Офтальмология / Учебные материалы / Vitreo-retinal Surgery Springer

Series Editors

Günter K. Krieglstein, MD

Professor and Chairman

Department of Ophthalmology

University of Cologne

Kerpener Straße 62

50924 Cologne

Germany

Robert N. Weinreb, MD

Professor and Director

Hamilton Glaucoma Center

Department of Ophthalmology

University of California at San Diego

9500 Gilman Drive

La Jolla, CA 92093-0946

USA

ISBN-10 3-540-33669-9

Springer Berlin Heidelberg NewYork

ISBN-13 978-3-540-33669-3

Springer Berlin Heidelberg NewYork

Library of Congress Control Number: 2006935425

This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from SpringerVerlag. Violations are liable for prosecution under the German Copyright Law.

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© Springer-Verlag Berlin Heidelberg 2007

Volume Editors

Bernd Kirchhof, MD

Professor and Chairman Department of Vitreo-retinal Surgery Center for Ophthalmology University of Cologne

Kerpener Straße 62 50924 Cologne Germany

David Wong, MD

Professor and Chairman

Department of Ophthalmology

Faculty of Medicine

University of Hong Kong

21 Sassoon Road, Pok Fu Lam

Hong Kong

ISSN 1612-3212

The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.

Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature.

Editor: Marion Philipp, Heidelberg, Germany

Desk Editor: Martina Himberger, Heidelberg, Germany Production: LE-TeX Jelonek, Schmidt & Vöckler GbR, Leipzig, Germany

Cover Design: Erich Kirchner, Heidelberg, Germany

Printed on acid-free paper 24/3100Wa 5 4 3 2 1 0

The series Essentials in Ophthalmology was initiated two years ago to expedite the timely transfer of new information in vision science and evidence-based medicine into clinical practice. We thought that this prospicient idea would be moved and guided by a resolute commitment to excellence. It is reasonable to now update our readers with what has been achieved.

The immediate goal was to transfer information through a high quality quarterly publication in which ophthalmology would be represented by eight subspecialties. In this regard, each issue has had a subspecialty theme and has been overseen by two internationally recognized volume editors, who in turn have invited a bevy of experts

to discuss clinically relevant and appropriate topics. Summaries of clinically relevant information have been provided throughout each chapter.

Each subspecialty area now has been covered once, and the response to the first eight volumes in the series has been enthusiastically positive. With the start of the second cycle of subspecialty coverage, the dissemination of practical information will be continued as we learn more about the emerging advances in various ophthalmic subspecialties that can be applied to obtain the best possible care of our patients. Moreover, we will continue to highlight clinically relevant information and maintain our commitment to excellence.

G. K. Krieglstein

R. N.Weinreb

Series Editors

This second edition promises to challenge our ideas about vitreoretinal surgery. As expected, some new and innovative techniques are described, the most exciting of which is the use of free retinal pigment epithelium patch grafts in patients with atrophic macular degeneration. We are interested in the advances that have made this surgery possible and look forward to the long-term outcomes. In the last couple of years, surgeons have become increasingly convinced by the advantages conferred by smaller gauge instruments, brighter and even safer lights, combined with an innovative viewing system to make routine surgery quicker and less traumatic for the patients. The use of 25-gauge for tumor biopsies is an exciting new development that represents a huge advantage over needle biopsies. The indication and the rationale for biopsies in cases of suspected uveal melanoma are presented.

There will always of course be difficult clinical decisions; choices have to be made despite the absence of good data based on randomized trials. A good example of a dilemma is whether to perform early vitrectomy for postoperative endophthalmitis. For this edition, we have opposing views from two surgeons. You simply have to read and decide for yourself. There are other controversies such as vitrectomy for floaters: the preparation in

terms of counseling, patient selection, and pitfalls are well covered in a chapter on the subject.

The chapter on macular holes examines the evidence behind our current practice. Despite the high success rate, a minority of patients will fail to respond to conventional surgery and a novel approach with heavy silicone oil is presented.

Sometimes, the skill of a surgeon is to know when not to operate. Asymptomatic inferior retinal detachment is another controversial area explored in a reasoned fashion, though no one knows for sure the cause of optical coherence tomography findings of subclinical macular retinal detachments.

Then we come to the big topic of tamponading. The need to apply scleral buckling, to adopt postoperative head-down posturing, or to use long-acting gas for inferior retinal breaks are being challenged as more rhegmatogenous retinal detachments are treated using primary vitrectomy and air alone. There is renewed interest in the techniques for draining subretinal fluid and the chapter on slippage explains how unwanted retinal folds can be avoided, whilst offering an easy technique for the exchange of fluids and the injection of silicone oil.

We hope you will enjoy reading this book as much as we have preparing it.

Bernd Kirchhof

David Wong

Editors

1.5Risk of Full-Thickness Macular Hole in the Fellow

1.7Fluorescein Angiography

and Fundus Autofluorescence 5

1.8Optical Coherence

Tomography . . . . . . . . . . . . . . . . 6

1.9Surgical Management of

Macular Holes . . . . . . . . . . . . . . . 6

1.10Technique for Conventional

Macular Hole Surgery . . . . . . . . 7

1.11Tamponade Agents

and Postoperative Posturing . . 8

1.12Biological Adjuncts

to Macular Hole Surgery . . . . . 9

1.13Technique for Intraoperative Application of Biological

Adjuncts . . . . . . . . . . . . . . . . . . . 10

1.14Inner Limiting Membrane

Peeling . . . . . . . . . . . . . . . . . . . . 10

1.15Technique for Inner Limiting

1.16Vital Staining to Facilitate Inner Limiting Membrane

1.19Technique for Inner Limiting

1.20Complications of Macular

Hole Surgery . . . . . . . . . . . . . . . 13

1.21Prognosis Following Macular

Hole Surgery . . . . . . . . . . . . . . . 13

Chapter 2

Heavy Silicone Oil for Persistent Macular Holes

Stanislao Rizzo, Federica Genovesi-Ebert

2.1.2.2Laser Photocoagulation and

2.2Treatment of Persistent

Macular Holes . . . . . . . . . . . . . . 22

2.2.1Heavier Than Water Silicone

Chapter 3

The Role of Combined Adjunctive

5-Fluorouracil and Low Molecular

Weight Heparin in Proliferative

Vitreoretinopathy Prevention

David G. Charteris, D. Wong

3.3.2Low Molecular Weight

3.4Clinical Trials of Combined Adjunctive 5FU and LMWH . . 35

3.4.2High-Risk Retinal Detachments in Eyes Undergoing Vitrectomy

and Gas Exchange (PVR 1) . . 36

3.4.3Established PVR in Eyes Undergoing Vitrectomy and Silicone Oil Exchange

(PVR 2) . . . . . . . . . . . . . . . . . . . . 36

3.4.4Unselected Primary Retinal Detachments in Eyes

Undergoing Vitrectomy

and Gas Exchange (PVR 3) . . . 36

3.4.5Macular Translocation with

3.5Implications for Clinical Use . . 37

3.5.1Uncomplicated Primary

3.5.4Intraocular Trauma Patients Undergoing Vitrectomy

Surgery . . . . . . . . . . . . . . . . . . . 37

Chapter 4

Slippage of the Retina: What Causes

It and How Can It Be Prevented?

David Wong

4.2.2Shape of Endotamponade

Bubble . . . . . . . . . . . . . . . . . . . . 42

4.2.3Surface Property

4.3.1Perfluorocarbon Liquids

4.3.4Oil on Water? No, Water

on Oil! . . . . . . . . . . . . . . . . . . . . . 47

4.4Overfilling and Complete

Chapter 5

Complete and Early Vitrectomy for Endophthalmitis (CEVE)

as Today’s Alternative to the Endophthalmitis Vitrectomy Study

Ferenc Kuhn, Giampaolo Gini

5.3Pathophysiology, Organisms, and Diagnostics

5.5.3Consequences of the EVS

Recommendations . . . . . . . . . 58

5.6Rationale for Performing Complete and Early Vitrectomy for

Endophthalmitis . . . . . . . . . . . 58

5.6.1Why Perform Vitrectomy? . . . 58

5.6.2Why Perform Early

Vitrectomy? . . . . . . . . . . . . . . . . 58

5.6.3Why Perform Complete

Vitrectomy? . . . . . . . . . . . . . . . . 59

5.7Complete and Early Vitrectomy for

5.7.10Enucleation/Evisceration . . . . 64

5.7.11Pharmacological Treatment . . 64

5.8Surgical Decision-Making

5.8.2Complications and Their

5.8.2.3Silicone Oil as a Long-Term

Tamponade . . . . . . . . . . . . . . . . 65

5.9Results with CEVE and Their

Comparison with the EVS . . . 66

5.10Summary

and Recommendations . . . . . 67

Chapter 6

Treatment of Acute Bacterial

Endophthalmitis After Cataract

Surgery Without Vitrectomy

Thomas Theelen, Maurits A.D. Tilanus

6.2.2Early Pars Plana Vitrectomy . . 75

6.2.3Nonvitrectomizing Endophthalmitis Treatment . . 76

6.3Emergency Management of Endophthalmitis After

6.3.2Equipment for the Emergency Management

6.3.4Treatment Outcome

in Endophthalmitis Without

Chapter 7

New Instruments in Vitrectomy

Masahito Ohji, Yasuo Tano

7.1 Introduction . . . . . . . . . . . . . . . 85

7.2Sutureless Transconjunctival

Vitrectomy . . . . . . . . . . . . . . . . . 85

7.2.125-Gauge Vitrectomy

7.2.3Surgical Procedures

7.2.4Advantage and Disadvantage of 25-Gauge

System . . . . . . . . . . . . . . . . . . . . 89

7.323-Gauge Vitrectomy

System . . . . . . . . . . . . . . . . . . . . 90

7.4Xenon Endo-Illumination

7.4.3.1Staining of Internal Limiting Membrane

8.2Diagnosis of Choroidal