🔴 Vitrectomy for Taut ERM & Macular Pucker 2X Stained with Brilliant Blue & Double Peel of ERM & ILM скачать в хорошем качестве

🔴 Vitrectomy for Taut ERM & Macular Pucker 2X Stained with Brilliant Blue & Double Peel of ERM & ILM

🔴 Vitrectomy for Taut Epiretinal Membrane and Macular Pucker Twice Stained with Brilliant Blue and Double Peel of ERM & ILM: This is inverted vitrectomy Vitrectomy for Taut Epiretinal Membrane and Macular Pucker Twice Stained with Brilliant Blue and Double Peel of ERM & ILM This is the preoperative OCT, showing a very adherent Epiretinal Membrane. The foveal shape is pretty much changed as well as the Central Retinal Thickness. We start the vitrectomy - the patient is phakic. There’s Hyaloid Asteritis and some vitreous haziness. Using a Wide Angle Vitrectomy Contact Lens we approach the macular area as well as the periphery. The hyaloid is detached, so that it can better help in the ILM staining after the air fluid exchange With a macular lens now we have a much better visualisation from the macula. Tortuous vessels can be observed. An air fluid exchange is carried out, that’s the next step. It’s gotta be a complete one, and that’s pretty much better for a better staining of the internal limiting membrane. Brilliant Blue is used to stain the ILM and other structures; the amount of adherences between the posterior hyaloid and the retina at the internal limiting membrane of Muller Cells attachments plays an important role on how much it’ll stain of not, depending on how much of the astrocytes are involved and proliferating in the virtual space between the posterior vitreous face and the retina. The staining was very good as you see most of the macular area is well stained with Brilliant Blue. A superior edge of the ILM IS approached and grabbed with the ILM Forceps, very gently. It is pulled down and horizontally, parallel to the retinal surface, uncovering the main central area. It was regrabbed temporally towards inferior macula and the action was completed. The ILM is then lifted for observation of its structure. Furthermore, some attachments around the vessels were also removed with an extra care not to cause any vessel disturbances. We kept removing these membranes to free up all macula off ILM Remains. Some were attached to epiretinal tissue from the posterior hyaloid and came along with the ILM The macular area is well displayed again with the Mac Lens and the inferior area shows a Pucker, not very well stained with the first AFX-Brilliant blue injection. Because of that we perform now another Brilliant Blue injection, but since we had already removed most of the Internal Limiting Membrane and the epiretinal tissue that came along with it, we could spill it straight on the macula. The lens was clear at all times and a good and bright view was guaranteed So with the ILM forceps one again this Pucker area was approached and most of the remaining epiretinal tissues were taken away. We believe that the chronic epiretinal tissue over the macula made it worse as to adhere on the macular surface, and the time between the diagnosis and the actual surgery, that was 9 months, without counting when the symptoms started, way before, played an important role in worsening that adherence and contributing to the pucker formation. Some endolaser where the sclerotomy sites were placed was made as a prophylaxis, thus avoiding any inadvertent tractions not noticed. These are the postoperative OCTs and Retinal Pics with angiography, from the patient in the 8th postoperative period. Retina settling down with no tractions and a a much better outcome. Pucker area is down below and getting towards normal anatomy. Thank you very much for your attention. We appreciate it.