(4K) Vitrectomy with Stand Up Technique for Dislocated Intraocular Lens (higher background sound) скачать в хорошем качестве

(4K) Vitrectomy with Stand Up Technique for Dislocated Intraocular Lens (higher background sound)

Affiliate to our channel Retinawesome: Retinawesome Retina & Vitreous International (YouTube)    / retinawesomeretinavitreousinternational   Surgical Description: Vitrectomy with Stand Up Technique for Dislocated Intraocular Lens The patient is Aphakic and has a one piece dislocated intraoculares lens. The IOL was on the macular area, threatening it and floating around the vitreous. Core and peripheral vitrectomy were performed, you see here trimming of the vitreous base. Switching to the other side vitreous is removed, paying attention to the cutter’s tip and avoiding reaching at the very far periphery, where you cannot see, to avoid touching retina. The intraocular lens has moved a bit superiorly. So now some measures have to be taken to avoid contact to the macula, because vitreous was just removed. Extreme care should be taken with intraocular pressure, and observing retinal periphery is of upmost importance A tiny 23 Gauge forceps was chosen for lifting IOL up but not quite after this step. So PFC - Perfluorocarbon Liquid - is used now with a 2-fold function: first is to withdraw IOL from the macular area and second is to actually lift up the intraocular lens to make it reachable in the best sense, for the forceps to catch at the lens. So PFC is around both sides of the IOL, a bubble, a smaller one, is holding it at the opposite site so that it stays vertical. So IOL was caught, but the lens was held firmly but probably not in the best position. Because it was not well held, it fell back again towards posterior pole. I was not even focused, attempting to place it at the anterior segment. Back to the arena, the IOL was stuck supero-nasally, at the very periphery, at the edge of perfluorocarbon - it was not easy to locate it. So the strategy now is a different one - IOL is so peripheral, and the geometry of the eye is actually doing the job of the PFC that was on the other side of the lens in the first attempt to remove it. So the IOL is just dislodged inferiorly with the illuminating pipe, until it got to the best and favorable position to be grabbed again. The IOL is now held at the angle between the Len’s Body and its haptic extension. That makes it a very strong catch. With the help of the illuminating pipe, the lens is supported until it is put over the previous rhexis, so that it would finally get in a stable position. Transillumination now displays good and stable IOL. Still over the iris to make vitrectomy safer, and to be repositioned by the end of the surgery. Time now to remove perfluorocarbon liquid passively, with a backflush cannula. No damage to the macula was noticed and the macular was well protected with PFC. The passive aspiration is the safest and should be made very slowly; keep intraoclar pressure on track so that not much pressure builds in. This 23 gauge cannula is good, but for smaller bubbles maybe a 25 makes it less dangerous and less likely to aspirate too fast. The last droplet should be aspirated. Endolaser to protect is performed, in a barrier shape. Final maneuvers now with the IOL as we finish the case. Thanks a lot for your attention.