Abstract
Even if occasionally other feedback types also come into play, the VR surgeon relies almost entirely on visual feedback to operate in the vitreous cavity. It is thus crucial that all elements that have a role in providing for optimal visual feedback are properly addressed. These elements include the viewing system (microscope, BIOM, contact lens), the cornea, the AC, the pupil (how it is made and kept wide), the lens and the IOL, and the vitreous cavity itself. In addition, the surgeon must avoid interfering with quality of the image by incorrectly manipulating the eyeball.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Notes
- 1.
The decision regarding the location where the membrane/strand is to be grabbed or what direction to be pulled is still made based on the visual feedback from the site and behavior of the membrane.
- 2.
Unlike, for instance, a general or trauma surgeon.
- 3.
With most items on this list, the solution to the problem is obvious; where it is not, a solution is proposed.
- 4.
Perspiration can occur even when the OR temperature is low (see Sect. 16.10). This, incidentally, enhances the condensation risk.
- 5.
See more in Sect. 16.5.
- 6.
This problem can be eliminated by the disposable BIOM.
- 7.
Repeated sterilization can cause irreversible reduction in light transmission.
- 8.
Move the lens toward 6 o’clock if what you want to increase the field of view toward 12 o’clock.
- 9.
A surface-coating visco is preferable; if a cohesive visco (e.g., Healon) is used, a drop of BSS on its surface helps smoothen it.
- 10.
Imbibition is a much more accurate term: the intracameral blood actually penetrates the stroma, not just stains the endothelial surface. The blood can take several months to spontaneously clear and prevent proper visualization of all posterior structures.
- 11.
The blood vessels may be present on either surface of the scar or inside it, hidden from view.
- 12.
As a general rule, the more chronic (old) the synechia, the greater the need to use sharp, rather than blunt instruments.
- 13.
In a concentration of 0.01%.
- 14.
See Sect. 39.1 about the rules of paracentesis.
- 15.
If for retractor use, I prefer making the paracentesis with a 25 or 27 g needle instead of a blade.
- 16.
It is not always necessary to insert all 4 (or 5, since certain manufacturers supply 5 in the box) retractors. Plan the number and location in advance and use the fewest possible.
- 17.
Collect them in the same way upon removal; then hand back all of them together to the nurse, rather than doing it one by one.
- 18.
In other words, it is not necessary to hook the iris at the exact location where the retractor first caught it.
- 19.
Malyugin ring (Microsurgical Technology, Redmond, WA, USA); Morcher Pupil Dilatator (Morcher GmbH, Stuttgart, Germany); Beehler Pupil Dilator (Moria SA, Antony, France).
- 20.
It is not adjustable such as with the retractors.
- 21.
Where the adhesion of the iris is strongest to the lens.
- 22.
Usually in older people.
- 23.
Although it occasionally happens even to experienced surgeons.
- 24.
Obviously, the width is determined by the gauge of the instrument. The linear opacity on one end points toward the sclerotomy where the instrument was inserted.
- 25.
The posterior capsule is not broken.
- 26.
Such as hydrophilic acrylic, biconvex lenses. This is why the capsulorhexis should be at least 4 mm in diameter.
- 27.
The capsule is usually too strong and rigid and offers no edge, for the probe to directly bite into.
- 28.
Alternatively, consider using a larger gauge and try to reduce the cut rate to a few hundred cpm.
- 29.
Only enough to wrap the jaws; otherwise, it will be difficult or traumatic to push the forceps into the AC.
- 30.
Once the cotton is wet, it becomes impossible to use it for wrapping.
- 31.
The anterior vitrectomy should have been completed beforehand.
- 32.
To avoid tearing the zonules or dislocating the IOL.
- 33.
I was asked to remove such lenses on a number of occasions.
- 34.
If the subluxation gave a lot of complaints to the patient, removing the IOL and replacing it with another one should be discussed preoperatively, during counseling (see Sect. 5.2).
- 35.
PFCL in an air-filled eye causes the same problem (see Sect. 14.4).
- 36.
Shockingly, some cataract surgeons still use silicone IOLs because they are less expensive.
- 37.
However, the probe can also be used. Typically it is sufficient to aspirate over the pool of blood. If the drainage is poor, immerse it in the blood, but be careful not to push the probe too deep into the blood so as to avoid injuring the yet-invisible retina.
- 38.
Commonly seen in diabetics.
- 39.
The technical difficulty is exacerbated by the presence of the cortical vitreous. The first step is thus the creation of a PVD.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Kuhn, F. (2016). Maintaining Good Visualization. In: Vitreoretinal Surgery: Strategies and Tactics. Springer, Cham. https://doi.org/10.1007/978-3-319-19479-0_25
Download citation
DOI: https://doi.org/10.1007/978-3-319-19479-0_25
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-19478-3
Online ISBN: 978-3-319-19479-0
eBook Packages: MedicineMedicine (R0)