Small-Gauge Vitrectomy for Diabetic Retinopathy

Description:

This book describes step by step how to operate on the patient with diabetic retinopathy. After thorough explanation of surgical planning, including the potential need to perform individual procedures at different time points, each stage of the vitrectomy is clearly documented with the aid of color photographs and drawings as well as online surgical videos. Variations in approach are described that are potentially of value, depending on whether one is dealing with a straightforward diabetic retinopathy or a difficult case of tractional retinal detachment. In the second part of the book, a series of case reports are presented that illustrate the surgical procedures applicable in different circumstances. In addition, pearls and pitfalls are highlighted.

Small-Gauge Vitrectomy for Diabetic Retinopathy, 2nd Edition has been updated in response to the rapid increase of diabetes worldwide and the technical advancements in ocular surgery. New chapters on anatomy, surgery and novel laser photocoagulation strategies for diabetic retinopathy also feature in this revised edition. This book is an ideal source of information and guidance for all who are embarking upon such surgery or wish to further hone their skills.

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Preface

Diabetic retinopathy is the biggest challenge for the VR surgeon. The challenge is twofold; on the one hand, the sheer volume of patients and on the other hand a difficult surgery with a big peroperative and postoperative complication spectrum. Lack of medical care and the immense volume of patients lead to very advanced cases of a tractional retinal detachment, which untreated often ends in blindness. The vitrectomy of a tractional retinal detachment is the most difficult and challenging ocular surgery. It divides VR surgeons in mediocre and experienced surgeons. Diabetic retinopathy is surgically very demanding because you operate an inflamed and vascular active tissue. The essentials for success are

1. Sequential phaco/vitrectomy

2. Preoperative anti-VEGF

3. Bimanual vitrectomy

We will demonstrate small gauge vitrectomies. We describe the surgery step-bystep. Just like a recipe in a cookbook. First, the ingredients and then step-by-step the preparation. If you follow the recipes you will master this pathology. All steps are visualized with photographs and short videos.

Our endeavour is to teach more people how to master the surgical management of the diabetic eye. We wish every reader, may he or she be a beginner or an advanced surgeon, to enjoy reading this book and watching the surgical videos. All videos of this book are found on the YouTube channel from Ulrich Spandau and playing list “Proliferative diabetic retinopathy”

Table of contents :
Preface
Contents
Abbreviations
Part IEssentials for Surgery of the Diabetic Eye
1 Introduction
1.1 Worldwide Facts About Diabetes
1.2 Regional Facts About Diabetes
1.3 The History of Diabetic Vitrectomy
References
2 Anatomical Pathology of Diabetic Retinopathy
2.1 Ischemic Retinopathy
2.2 Anatomical Pathology of a Proliferative Diabetic Retinopathy (PDR)
2.2.1 Formation of Fibrovascular Membranes
2.2.2 Status of the Posterior Hyaloid
2.2.3 Vitreous Hemorrhage
Reference
3 Hot Topics Regarding Vitrectomy for PDR
3.1 Pretreatment or Not—That is the Question
3.2 Complications of No Pretreatment
3.3 Sequential or Combined Phaco-Vitrectomy?
3.4 Immediate Vitrectomy? Yes or No?
3.5 Summary
References
Part IITreatment Planning
4 Surgical Scenarios
Reference
5 Indication and Aim of Vitrectomy of a Diabetic Eye
5.1 Indication and Aim of Vitrectomy
5.2 Do Not Operate on These Patients
6 Treatment Planning
6.1 Preoperative Intravitreal Anti-VEGF and Sequential Phaco/Vitrectomy
6.2 Surgery of Easy Diabetic Vitrectomy
6.3 (Surgical) Difficult Diabetic Vitrectomy Case, Where Retina Already Pretreated with Scatter Laser
6.4 (Surgical) Difficult Diabetic Vitrectomy Case NOT Pretreated with Scatter Laser
Part IIIGeneral Aspects and Surgical Techniques About Anti-VEGF, Laser Photocoagulation and Vitrectomy for Diabetic Retinopathy
7 General Aspects and Surgical Techniques About Anti-VEGF, Laser Photocoagulation and Vitrectomy for Diabetic Retinopathy
7.1 Three Weapons Against Diabetic Retinopathy
7.2 Preoperative Anti-VEGF-Treatment
7.3 Laser Treatment: Laser Indirect Ophthalmoscopy (LIO) and Endolaser
7.4 Cryopexy
7.5 Don’t Forget the Fellow Eye
7.6 Two-Step Phaco/Vitrectomy: Phaco + Anti-VEGF-Treatment
7.7 Diabetic Vitrectomy
7.7.1 Monomanual Vitrectomy
7.7.2 Bimanual Vitrectomy
7.8 Take Home Message: Ten Recommendations for VR Surgery of TRD Secondary to Diabetes
References
Part IVSurgery of Easy Diabetic Retinopathy
8 Surgery of Easy Diabetic Vitrectomy
8.1 Anaesthesia for Easy Diabetic Vitrectomy
8.2 Treatment Planning for Easy Diabetic Vitrectomy
8.3 Sequential Phacoemulsification and Anti-VEGF Treatment
8.4 Easy Diabetic Vitrectomy
8.4.1 Introduction
8.4.2 Surgery
8.5 Surgery of Easy Diabetic Vitrectomy Vitrectomy Case with ATTACHED Posterior Hyaloid
8.6 Complications
8.7 FAQ
Part VSurgery of Difficult Diabetic Vitrectomy
9 Instruments and Surgical Techniques for Difficult Diabetic Vitrectomy
9.1 Instruments
9.1.1 Vitreous Cutter
9.1.2 Illumination for Bimanual Vitrectomy
9.1.3 Instruments for Hemostasis
9.1.4 Instruments for Peeling of Fibrovascular Membranes
9.1.5 Dyes
9.1.6 Instruments for Laser Treatment
9.1.7 Summary
9.2 Surgical Techniques for a Difficult Diabetic Vitrectomy
9.2.1 Chandelier Light
9.2.2 Posterior Hyaloid Rhexis
9.2.3 Posterior Vitreous Separation
9.2.4 Bimanual Peeling and Essential Instruments
9.2.5 Removal of Membranes Located on the Vessel Arcade
9.2.6 Hemostasis
9.2.7 Injection of PFCL
9.2.8 Posterior Hyaloid Removal on the Nasal Pole
9.2.9 Scatter Laser Treatment
Reference
10 Surgery of Difficult Diabetic Vitrectomy
10.1 Anaesthesia for Difficult Diabetic Vitrectomy
10.2 Treatment Planning for Difficult Diabetic Vitrectomy
10.3 Difficult Diabetic Vitrectomy
10.4 Complications
10.5 FAQ
11 Surgery of Laser Untreated Difficult Diabetic Vitrectomy
11.1 Laser Indirect Photocoagulation of the Retina
11.1.1 Introduction
11.1.2 Instruments for Laser Coagulation
11.1.3 Laser Treatment Step by Step
11.1.4 Conclusion
11.2 Case Reports for Laser Untreated Difficult Diabetic Vitrectomy
Part VIUnusual and Difficult Cases Including Neovascular Glaucoma
12 Unusual and Difficult Cases
12.1 Advanced Proliferative Diabetic Retinopathy Without PVD—Double Vitrectomy
12.2 Membrane Removal with Disc to Periphery Technique
12.3 Severe Intraoperative Bleeding, “The Bloody Eye”
13 Neovascular Glaucoma
13.1 Treatment Planning for Neovascular Glaucoma
13.2 The Surgery
Part VIISurgical Failures and Postoperative Complications
14 Surgical Failures
14.1 “Easy” PDR with Completely Attached Posterior Hyaloid
14.2 Retinal Detachment After Cryopexy
14.3 Retinal Defects After Complicated Vitrectomy
14.4 Hypotony After Several Vitreoretinal Surgeries Secondary to PDR
14.5 Displacement of the Macula After Resorption of Subretinal Fluid
14.6 Surgery of an Eye with Iris Rubeosis
15 Postoperative Complications and Management
Part VIIICase Reports
16 Case Reports
16.1 Swedish Patients
16.2 Serbian Patients
Surgical Materials
19 Companies
Index