Zoran Tomic

A two-year prospective study comparing lidocaine 2% jelly versus peribulbar anaesthesia for 25G and 23G sutureless vitrectomy

PurposeTo evaluate the efficacy of topical lidocaine 2% gel with or without peroral preoperative sedation as an alternative anaesthetic method in sutureless vitreoretinal surgery.Material-methodA prospective study was designed to assess the intraoperative and postoperative pain, using a visual analogue scale (VAS) in three groups of patients, comprised of 23 patients each. The first group included cases that were operated with 25-gauge (25G) instruments under topical anaesthesia with lidocaine jelly, the second group with 23-gauge (23G) under the same topical anaesthesia and finally the third group (control group) with sutureless (23- or 25-gauge) vitrectomy under peribulbar anaesthesia. Mann Whitney U test was used to compare the results. The subjective surgeon’s opinion about the difficulty of each procedure was recorded on a 1–5 scale and the results were evaluated with a chi-square test.ResultsNo statistically significant difference in the level of pain was detected between the three groups. Topical anaesthesia vitrectomy procedures were performed more easily (p = 0.0002) with 23-gauge than with 25-gauge instruments. The painful steps of the surgery that were capable of causing moderate to severe pain were endolaser, scleral indentation and peribulbar injection. The goal of the operations was accomplished in all cases.ConclusionLidocaine 2% jelly with or without peroral preoperative morphine and dixyrazine offers adequate analgesia to perform sutureless vitrectomy. Lack of akinesia does not prevent a successful surgical result.

Traumatic Retinal Detachment Secondary to Open Globe

Trauma presents with a huge variety. Not one traumatic case can be compared with the other. This makes trauma surgery exciting and demanding but makes also recommendations for surgical procedure rather difficult. Generally, a globe injury is divided into an open globe injury and a closed globe injury. Here we will only talk about open globe injuries. For open globe injury, two major traumas are possible: (1) an ocular injury with intraocular foreign body (IOFB) and (2) globe injuries affecting the sclera (scleral injury) or the cornea (corneal injury). Remark: A corneal injury is often called a perforation, and a scleral rupture is also named a globe rupture. (See Fig. 22.1 (Videos 22.1, 22.2, 22.3, 22.4, 22.5 and 22.6).)

Traumatic Retinal Detachment in Children

This chapter is about three aspects of ocular trauma: firstly the surgical management of traumatic retinal detachment in children with episcleral buckling, secondly the surgical management of an open globe rupture, and thirdly the surgical management of intraocular IOFB with delayed vitrectomy.

Vitreoretinal Surgeons Assess Surgical Cases: A Questionnaire

This PVR summary was performed after analysing 30 PVR questionnaires from expert vitreoretinal surgeons. There are many tips and tricks shared by many of them despite they are referred to only one. I want to appreciate their kind collaboration with this chapter.

Pneumatic Retinopexy with BIOM

The surgical technique of pneumatic retinopexy is described in detail. The surgery is performed with a microscope and a BIOM. An indirect ophthalmoscope is not used.

Recurrent Retinal Detachment

The main question when examining the retina of a recurrent detachment is: Where is the hole? If a new hole is present, we would operate the eye as a primary detachment. But in many cases, a retinal break cannot be found. In this case a minihole must be searched for. This minihole is often a laser necrosis and located at the edge of a laser scars. In order to localize the hole, you must remember the Lincoff rules and use the following trick: Inject PFCL posterior to the suspected hole and look for Schlieren. Schlieren is subretinal fluid which enters the vitreous cavity through the hole. Search for the hole using a light fiber and scleral depressor.

Perforations with IOFB

The following chapter describes the surgical management of a penetrating eye injury by IOFB. Two different surgical approaches are described: the delayed, stepwise surgery and the immediate surgery.

Vitrectomy for PVR Detachment Grade C

The following chapter describes step by step the surgical technique of a vitrectomy of a PVR detachment grade C.

Combined Phaco/Vitrectomy for Easy Retinal Detachment

The following chapter demonstrates step-by-step the surgical technique of a combined phaco/vitrectomy for an easy retinal detachment.

PVR Stage D

PVR stage D with closed funnel without view to optic disc (Fig. 20.1) is surgically the most demanding and most difficult pathology within PVR detachments. The retina is stiffened with full-thickness retinal folds. A circumferential traction leads to a purse string funnel detachment. The surgical aim is to remove these tractional forces and mobilize the retina (Video 20.1).