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Yusuke Oshima, MD
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A 13-year-old boy underwent a 25-gauge vitrectomy with scleral buckling and crystalline lens removal for treating advanced proliferative vitreoretinopathy in the right eye. The intraoperative fundus findings viewed through a wide-angle viewing system (WAV) shows a total retinal detachment complicated with prominent fibrovascular membrane proliferation reaching the periphery. The tough and thickened cyclic membranes formed at the periphery are the most challenging to treat with a conventional single-hand technique. In contrast, bimanual manipulation viewing through the WAV under the chandelier endoillumination is a safe and practical technique for membrane removal. In this case, even the cyclic membranes at the periphery can be easily dissected and separated from the detached retina bimanually with a membrane forceps and scissors or a vitreous cutter. Bimanual manipulation in conjunction with the WAV and chandelier endoillumination is a critical and helpful technique for expanding the indications of small gauge vitrectomy to challenging cases.
Posted: 8/22/2012
Yusuke Oshima, MD
A 13-year-old boy underwent a 25-gauge vitrectomy with scleral buckling and crystalline lens removal for treating advanced proliferative vitreoretinopathy in the right eye. The intraoperative fundus findings viewed through a wide-angle viewing system (WAV) shows a total retinal detachment complicated with prominent fibrovascular membrane proliferation reaching the periphery. The tough and thickened cyclic membranes formed at the periphery are the most challenging to treat with a conventional single-hand technique. In contrast, bimanual manipulation viewing through the WAV under the chandelier endoillumination is a safe and practical technique for membrane removal. In this case, even the cyclic membranes at the periphery can be easily dissected and separated from the detached retina bimanually with a membrane forceps and scissors or a vitreous cutter. Bimanual manipulation in conjunction with the WAV and chandelier endoillumination is a critical and helpful technique for expanding the indications of small gauge vitrectomy to challenging cases.
Posted: 8/22/2012
![[2019] Amniotic Membrane Placement for Repair of Recurrent Macular Hole](https://d33x7gwyb2b5z6.cloudfront.net/eyetube/thumbs/gldaw.jpg?auto=compress,format&w=180)
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Yusuke Oshima
12 years ago
Thanks for your interest. This video is recorded by a high-quality camera (MKC-307) with its imaging control device from the Ikegami Ltd.(http://www.ikegami.co.jp/global/index.html)
Bhushan Khare
12 years ago
Dear Dr Oshima Congratulating you on the amazing video clarity seen in HD. What recording system have you used pl regards Dr B Khare Pune, India
neeraj pandey
13 years ago
dear dr. oshima, amazing video quality! i would like to know which WAV chandelier are you using here? looks like a contact lens with inverter. do you have to change this contact lens for posterior pole surgeries or you can continue with the same e.g. ILM peel and membrane dissections close to macula?
Yusuke Oshima
13 years ago
Thank you very much for the interest in this video clip. The chandelier fiber system I used here is a 25G-VIVID chandelier fiber from the Synergetics Inc. I have used a special adapter for connecting this fiber to the xenon light featured in the Constellation Vision System. Recently, we further developed a 27G-VIVID chandelier optic fiber, which will be launched at the AAO annual meeting this year in Chicago. The WAV system I use is the Resight, a non-contact type WAV system from the Carl Zeiss. The 128D WAV pre-placed lens is very helpful for both peripheral and posterior viewing. Please refer to the detailed information described in the September issue of Retina Today. Basically, I just use the 128D pre-placed lens for most of intraocular manipulation including peripheral vitreous shaving, membrane dissection, and epiretinal membrane peeling as shown in this vdeo clip. For BBG-assisted ILM peeling, I prefer to change it to a 60D magnifying pre-placed lens (Carl Zeiss) or a conventional contact lens. I hope the information described here will be of your help. Thanks.