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Recurrent Epiretinal Membrane and New Peeling after Brilliant Blue Staining and sparing the ILM скачать в хорошем качестве

Recurrent Epiretinal Membrane and New Peeling after Brilliant Blue Staining and sparing the ILM 3 года назад

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Recurrent Epiretinal Membrane and New Peeling after Brilliant Blue Staining and sparing the ILM
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Recurrent Epiretinal Membrane and New Peeling after Brilliant Blue Staining and sparing the ILM

This is inverted Vitrectomy Recurrent Epiretinal Membrane and New Peeling after Brilliant Blue Staining and Sparing the Internal Limiting Membrane This is the patient’s Right eye, not elective for a surgery, longstanding Retinal Detachment The Left Eye as the OCT shows had this Epiretinal Membrane with distortion of the foveal depression; this was June, 2021, 20/60 best corrected visual acuity This patient had two surgeries, one for 1ry epiretinal membrane, in 2021, and another one in 2022, a recurrent one The Patient is Pseudophakic A 23G pars plana vitrectomy was initiated - that was the 1st surgery The hyaloid was not detached and the patient had a dense hyaloid asteritis So after vitrectomy and a complete Air Fluid Exchange and Brilliant Blue Injection, we could well observe this epiretinal membrane reflex off the retina using a high power macular lens. With a 23G ILM forceps we grabbed the epiretinal tissue, and removed it “En Bloc”, unveiling the macular surface. The patient eventually reached 20/50 (0.39) to 20/45 (0.35) but got worse after 6 months from the surgery. Seven months later the vision had dropped to 20/80 and after the patient was diagnosed with a recurrent epiretinal membrane, he was set for another vitrectomy. We have this great macular lens view from the posterior pole, preparing already for an Air Fluid Exchange - AFX - ‘cause there was not much vitreous work. A complete AFX was carried out Brilliant Blue was then injected on the macula We decided to use a 25G ILM forceps to start working in the macular surface. This was a very tiny one because the membrane was not that thick as it was primarily removed in the 1st procedure. This one was not easy to remove so a shaving strategy was created to sort of pass over the mac surface with the forceps being extra careful not to go any deep. The contrast between the stained internal limiting membrane and the stained edges of the epiretinal tissue at their interwoven junction made it possible to apply that shaving manoeuvre. Some ILM areas were not so well stained due to probably astrocyte and Muller cell proliferation at the interface, covering the ILM irregularly. Still, it was possible to well visualize all the magnified area and the contact lens made it pretty clear associated with a correct zoom option. We are here rubbing lightly on the surface in an attempt to find the epiretinal tissue We finally found a parallel plane on the retinal surface, but it took a while before we could actually reach the epiretinal tissue and grab it, removing it from the central macular area, without any harm. The epiretinal tissue was then grabbed and with a horizontal parallel action it was detached. We called this a kind of “Flag’s Sign”, because the illumination towards the membrane from the light pipe displayed a shadow on the retina, trembling like a flag. We got to the conclusion that less is more and as the epiretinal tissue was removed we ended up with a clear surface freed from any interface traction or unwanted material A very good look at the macula with good magnification showed it free of any epiretinal tissue after the shave and peel manoeuvres. The smaller gauge of the ILM tip really makes a difference. Endolaser was the next step then, so as to protect retinal periphery Another AFX is performed by the end of the procedure That’s about it, we do appreciate your attention

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