🔴 Sub ILM Hemorrhage Post Valsalva Retinopathy Treated with TPA & Gas & later Pars Plana Vitrectomy скачать в хорошем качестве

🔴 Sub ILM Hemorrhage Post Valsalva Retinopathy Treated with TPA & Gas & later Pars Plana Vitrectomy

Title: Sub ILM Hemorrhage Post Valsalva Retinopathy Treated with TPA & Gas & later Pars Plana Vitrectomy This is inverted vitrectomy Sub ILM (Internal Limiting Membrane) Hemorrhage Post Valsalva RETINOPATHY Treated with TPA (Tissue Plasminogen Activator) & Gas & later Pars Plana Vitrectomy This is before TPA injection with SF6 Gas Two weeks after TPA + SF6 Gas injection the hemorrhage is starting to resorb This is one month out after TPA + SF6 Gas injection We start the vitrectomy. The patient is Phakic Media is little hazy due to some vitreous opacities By using a Wide Angle Contact Lens is easy to remove central vitreous and peripheral opacities, vitreous debris and hemorrhage partially resorbed Peripheral vitreous and attached hyaloid are removed altogether carefully avoiding hitting the lens and a good way to do that is tilting the eye towards the area you wanna reach, so that the cutter and light pipe shaft go underneath the lens without touching it at all An Air Fluid Exchange is set up for the aim of staining the ILM by injecting Brilliant Blue into the Vit Cavity should it be a complete one so that the ILM is best stained that way, just as needed. The action of TPA, tissue plasminogen activator, before the vitrectomy is a very interesting manoeuvre, because if you do vitrectomy with full and untreated sub ILM hemorrhage , massive vitreous hemorrhage coming through the broken membrane can halt the main steps of the surgery for some time, taking an extra time removing this vitreous hemorrhage, increasing the total surgical time, as well as the likelihood of intraoperative complications. That’s why it is safer to inject intravitreous TPA before the vitrectomy. Brilliant Blue is next step then We switch to another lens, a Contact Macular, high power. The staining was pretty cool and some sub Internal Limiting Membrane Hemorrhage, partially resorbed, can be seen superiorly, trapped by the ILM, though With the ILM Forceps you grab the ILM and move it in a spinning movement. You gotta go horizontal like walking over the retina surface, so that the vectorial forces follow the way dictated by the forceps tip. The membrane comes out beautifully, and it is possible, like a capsulorrhexis, to make it wider enough so as to free up all macular area. Watch out for any adherences and keep the eye on the field at all times. You can extend widely the peel if you wanna remove any additional sub ILM hemorrhage you may find on the way. Because the adherences close to the retina vessels may make the action a little more dangerous due to their presence there, combination forces associated with vectorial direction and slow movement are of upmost importance in order not to cause a retinal tear at this time. Endolaser is the next step just in case, to avoid any unseen traction that could possibly, although rarely, have caused any peripheral iatrogenic break. That’s about it! Thank you very much for your attention.