Surgical Videos

Treatment of an epiretinal membrane with 27-gauge pars plana vitrectomy. A 57-year-old lady presented with decreased visual acuity and metamorphopsia. Her best corrected visual acuity measured 20/50. 27 G synergetic vitrectomy system was used. Cannulas were inserted straight in without beveling. TRIESENCE® 4mg/0.1 cc was injected to assist with visualization of the posterior hyaloid face. This was followed with indocyanine green (ICG) dye 0.5%. The ICG was allowed to sit against the internal limiting membrane and epiretinal membrane for 60 seconds after which it was completely removed using a soft-tip cannula. The ILM and ERM peel was preformed en-block using 27 G Eckhardt’s forceps. Finally, air/fluid exchange was performed. Post-operatively, the patient’s vision improved to 20/30, and the metamorphopsia resolved.
Chronic Vitreous Hemorrhage - Proliferative Diabetic Retinopathy - by Dr. Amir Hadayer
The first iOCT assisted epiretinal membrane (ERM) peel retina micro-surgery performed at the University of Louisville. The iOCT (ReScan 700, Zeiss) is an advanced microscope integrated imaging machine that enables the precise visualization of pan-retinal scans at real-time to the surgeon during the performance of delicate surgical procedures. The University of Louisville Retina Service (operating at Jewish Hospital surgery center downtown Louisville) was the fourth place in the nation that this novel machine was successfully used to assist in complex retina surgeries. iOCT presents an innovative promising technology to allow greater understanding of the delicate and precise intra-ocular surgical maneuvers involved in retinal surgery. The University of Louisville retina surgeons are international leaders in the field of retina surgery, who provide cutting edge retina care to patients in the greater Louisville area.
25 Gauge Vitrectomy for Retained Lens Fragments
The removal of 5000 Centistokes silicone oil using a sutureless 25G vitrectomy technique. A 54-year-old Caucasian female underwent scleral buckling and 20G vitrectomy surgery with 5000 centistokes silicone oil injection for the repair of a retinal detachment with proliferative vitreo-retinopathy. Silicone oil removal was performed six months later. The video presents the insertion of three 25G trocars in a beveled manner and silicone vacuum tube connection to an adapter which is placed over the superior temporal port. Aspiration and removal of silicone oil and fluid air exchange to washout any remnant oil bubbles followed by removal of the trocars is demonstrated.

Minimally invasive 25 gauge vitrectomy surgery for visually significant dense asteroid hyalosis. A 50 year old Caucasian gentleman presented with 20/50 vision secondary to dense, white, asteroid hyalosis resembling a holiday season snow storm. Minimally invasive vitrectomy surgery was suggested to clear the visual axis from the persistent flecks. 25 gauge trocars were inserted in a beveled manner at the pars plana. Meticulous anterior vitrectomy was performed, followed by core vitrectomy with partial air/fluid exchange. The patient improved to 20/20 vision within a week.

Treatment of taut posterior hyaloid with 27-gauge DORC vitrectomy system. A 82-year-old lady presented with decreased vision and metamorphopsia. 27 G Cannulas were inserted straight in, without beveling. High flow infusion cannula was connected to maintain adequate IOP. Preservative free triamcinolone acetonide 4mg/0.1 cc was injected followed by indocyanine green dye 0.5%. ERM peel was preformed en-block using 27 G Eckhardt’s forceps. Finally, air/fluid exchange was performed. Post-operatively, the patient’s vision improved to 20/20, and the metamorphopsia resolved.