Περιγραφή
The vitreous humour is a clear gel positioned behind the iris (coloured part) and the lens, and in front of the retina (back of the eye). Vitrectomy is the surgical removal of the vitreous humour, a procedure needed to allow ophthalmic surgeons to diagnose and treat underlying disease in the eye.
Small gauge minimally invasive vitreous surgery (MIVS) allows ophthalmic surgeons to make smaller incisions, reducing the need for sutures and therefore increasing the speed of recovery.
This practical book presents ophthalmic surgeons with the most recent advances in MIVS, with emphasis on the differences between gauge sizes.
Beginning with an introduction to the technique and anaesthesia, the following chapters discuss MIVS for different disorders.
More than 190 full colour images and illustrations, and a DVD demonstrating MIVS procedures help retinal surgeons learn how to minimalise surgical trauma by reducing the gauge size of vitrectomy instruments.
Key points
- Presents ophthalmic surgeons with most recent advances in minimally invasive vitreous surgery
- Emphasis on differences between gauge sizes
- Includes DVD demonstrating surgical procedures
- Comprehensive text enhanced by more than 190 colour images and illustrations
Περιεχόμενα
1. introduction and Anesthesia………………………………………..1
Shalabh Sinha
• Anesthesia 3
• General anesthesia 7
• Dressing and draping 8
2. Technological Support for miVS …………………………………11
Kapil Bhatia, Ajit Babu Majji, Meena Chakrabarti
• Valved cannula 15
• Insertion trocar 15
• Infusion cannula 17
• Vitreous cutters 17
• Other disposable instruments 19
• Endoillumination 21
• Cone of illumination 21
• Led endoilluminators 24
3. Faster Visual Recovery with miVS ……………………………..30
Raja Narayanan, Anshuman Sinha, Baruch D Kuppermann
4. microincision Vitrectomy—incision …………………………….32
Abhishek Kothari, Narendran V, Amit Gupta
• Microincision wounds 32
• Attributes of MIVS incisions 32
• MIVS wound variants 34
• MIVS wound construction 34
• Incision closure 37
5. 25 Gauge Vitrectomy overview …………………………………..40
Saurabh Luthra
6. 23 and 25 Gauge Vitrectomy: An overview ………………….45
Pramod Bhende, Sudipta Das
• Ideology 45
• History 46
• Vitrectomy machine parameters 46
• Advantages of MIVS 48
• Decision making 49
• Preferred indication of MIVS 49
• Limitations of MIVS 50
7. 27 Gauge Vitrectomy System ……………………………………..54
Yusuke Oshima
• 27 gauge illumination system (Light source and fibers) 54
• 27 gauge vitreous cutter 59
• 27 gauge surgical instruments 59
• Clinical experiences with 27 gauge system 63
• Future pespective 65
8. miVS in macular Hole …………………………………………………67
SN Jha
• Clinical features and work up 67
• Signs 67
• Investigations 68
• Natural history 69
• Types of macular hole 69
• Pathogenesis 70
• Stages of development of senile macular hole by Gass 70
• OCT based prognosis 72
• Macular hole surgery 74
• Surgical technique 74
• MIVS and changing paradigm in macular hole surgery 76
• Postoperative posturing 77
9. miVS for Vitreoretinal interface Disorders …………………..81
Alay S Banker, Rohan Chauhan
• Vitreoretinal macular traction syndrome …………………………..81
• Epiretinal membrane ……………………………………………………84
10. microincision Vitrectomy System in PDR ……………………93
Cyrus Shroff, Charu Gupta
• Small gauge vitrectomy 93
• Endoillumination 97
• Viewing system 98
• Indications for surgery 98
• Surgical technique 100
• Lens status 103
• Sclerotomies 104
• Vitrectomy 104
• Membrane dissection 105
• Hemostasis 106
• Tamponade 107
• Photocoagulation/cryotherapy 107
• Closure 107
• Complications 108
• Postoperative hypotony 108
• Postoperative vitreous hemorrhage 108
• Postoperative retinal detachment 109
11. Small Gauge Vitrectomy in Endophthalmitis ……………..112
Gopal S Pillai, Lalit Verma
12. miVS in Vitreous Hemorrhage …………………………………..116
Saurav Sinha
• Vitreous hemorrhage 116
• Proliferative diabetic retinopathy 117
• Vascular occlusions 118
• Eales disease 118
• Trauma 119
• Special considerations in MIVS for vitreous hemorrhage 119
• Complications specific to MIVS for vitreous hemorrhage 120
13. miVS for Retinal Detachment …………………………………..122
Harsha Bhattacharya
• Historical background 122
• Instrumentation 123
• Basic surgical technique 124
• Complications 128
• Advantages 129
• 23 gauge vitrectomy outcomes 129
14. miVS in macular Edema ……………………………………………132
Atul Kumar, Subijay Sinha, Varun Gogia
• Macular edema in vascular occlusions 133
• Vitrectomy in diabetic macular edema 135
15. Silicone oil in miVS …………………………………………………142
Shalabh Sinha
• Injection of silicone oil 142
• To suture or not to suture the sclerotomies while
using silicone oil 145
• Removal of silicone oil 145
• Combined surgery with silicone oil 146
• Complications of silicone oil in MIVS 147
16. Combined Cataract and Vitreoretinal Surgery ……………150
Shobhit Chawla
• Some pearls 153
17. Hybrid Vitrectomy …………………………………………………….155
Manish Nagpal
• How recent advances have addressed early small gauge
concerns? 157
• Trocar-cannula system 160
• Different types of incisions 161
• Extended hybrid techniques 163
18. 20 Gauge Sutureless Vitrectomy……………………………….167
C Claes, AP Lafetá
• Instrumentation and technique 168
• Discussion 171
19. Complications in miVS ……………………………………………..173
Priyank Garg, Arindam Chakravarti, Sundaram Natarajan
• Intraoperative complications 173
• Postoperative complications 175
• Wound leak/hypotony 175
• Wound healing 175
• Cataract 176
• Endophthalmitis 176
• Vitreous hemorrhage 177
• Vitreous incarceration and retinal detachment 177
• Others 178
20. improved Visualization for microincision
Vitreous Surgery ………………………………………………………181
Meena Chakrabarti, Sonia Rani John, Arup Chakrabarti
• Wide-angle vitrectomy lens systems 182
• Autoclavable lenses 185
• EIBOS 191
• PWL 192
• Resight 700 192
Index ………………………………………………………………………………….195
