In the Press
Retina Associates of Kentucky is continuing to pioneer the use of advanced viewing technology in retinal surgery. This week we were the first retinal surgeons to use the Zeiss 3D system for retina. We also are using advanced intraoperative OCT for real time precision surgical outcomes.
- Anti-VEGF Agents Changing Diabetic Retinopathy Treatment Paradigm
- Comparative-Effectiveness Study Confirms New Treatment for Diabetic Macular Edema Ranibizumab Injections Plus Laser Therapy Results in Dramatic Visual Improvement
- Pearls for Reducing the Risk of Adverse Surgical Outcomes
- FDA approves intravitreal ranibizumab for treatment of diabetic macular edema
- Management of Hemorrhagic Choroidal Detachment
- EYETUBE: Choroidal Drainage
- Observational study of subclinical diabetic macular edema
- EYETUBE: Synergetics 29-gauge Duel Chandelier Light
- The Advent of Chandelier Illumination in Vitreoretinal Surgery
- EYETUBE: Extreme Buckling
- Moving Beyond the "Wow Factor"
- Implementation of Ultra-Widefield Retina Imaging
- Extreme Buckling
- Applying Ultra-Widefield Angiography in Diabetes and Other Inflammatory Diseases
- SURGICAL UPDATES: The Next Generation Machines for Modern Vitrectomy
- Modified external needle drainage of subretinal fluid in the management of rhegmatogenous retinal detachment using a "guarded needle" approach
- The vitreous trap: a simple, surgeon-controlled technique for obtaining undiluted vitreous and subretinal specimens during pars plana vitrectomy
- EYETUBE: Trans-Scleral Surgery
- The Uncharted Realm of the Retinal Periphery
- SURGICAL UPDATES: Transscleral Surgery
- SURGICAL UPDATES: Creating Quality Surgical Videos
- EYETUBE: Editing Surgical Videos with iMovie
- Triamcinolone acetonide preparations: impact of crystal size on in vitro behavior
- Medrounds: Technology Update
- Retinal breaks observed during pars plana vitrectomy
- Indocyanine green-assisted internal limiting membrane peeling for macular holes: toxicity?
Anti-VEGF Agents Changing Diabetic Retinopathy Treatment Paradigm
01/23/2013 -The traditional first line treatment paradigm for proliferative retinopathy and clinically significant diabetic macular edema has been laser treatment followed by surgery in advanced cases, but that is shifting with the approval of an anto-VEGF agent. - Continue reading.
Comparative-Effectiveness Study Confirms New Treatment for Diabetic Macular Edema Ranibizumab Injections Plus Laser Therapy Results in Dramatic Visual Improvement
10/18/2012 -Comparative-Effectiveness Study Confirms New Treatment for Diabetic Macular Edema Ranibizumab Injections Plus Laser Therapy Results in Dramatic Visual Improvement -Continue reading here.
Pearls for Reducing the Risk of Adverse Surgical Outcomes
10/01/2012 -Long before a patient is under the surgical drape and you are about to insert the first cannula into the eye, it is important to consider criteria for who is a good surgical candidate. The foundations of a good surgical outcome are laid in the clinic. To follow are critical pearls toward successful surgery - Continue reading here.
FDA approves intravitreal ranibizumab for treatment of diabetic macular edema
09/10/2012 -The U.S. Food and Drug Administration has approved the use of once-monthly 0.3-mg intravitreal ranibizumab for the treatment of diabetic macular edema, according to a press release from Genentech. Continue reading here.
Management of Hemorrhagic Choroidal Detachment
09/01/2012 -Hemorrhagic choroidal detachment can be an unfortunate complication of ophthalmic surgery with significant ocular morbidity. Often, vitreoretinal surgeons are involved in the management of such cases; however, evidence to support a standardized approach to the treatment strategy or surgical drainage techniques is not well established. In this month’s discussion, a panel of Vit-Buckle Society (VBS) members answers key questions regarding their approaches to the management of this often challenging condition. Our esteemed panel consists of VBS members Thomas Albini, MD; Jonathan Prenner, MD; John Kitchens, MD; Charles Mango, MD; and Andrew Moshfeghi, MD, MBA. Continue reading here.
EYETUBE: Choroidal Drainage
08/03/2012 -n this video, John Kitchens, MD, takes a close look at how choroidals drain during surgery and techniques that may be helpful for the drainage of serous choroidal detachment. Continue reading here.
Observational study of subclinical diabetic macular edema
To determine the rate of progression of eyes with subclinical diabetic macular edema (DME) to clinically apparent DME or DME necessitating treatment during a 2-year period.
In all, 43 eyes from 39 study participants with subclinical DME, defined as absence of foveal center edema as determined with slit lamp biomicroscopy but a center point thickness (CPT) between 225 and 299 μm on time domain (Stratus, Carl Zeiss Meditec) optical coherence tomography (OCT) scan, were enrolled from 891 eyes of 582 subjects screened. Eyes were evaluated annually for up to 2 years for the primary outcome, which was an increase in OCT CPT of at least 50 μm from baseline and a CPT of at least 300 μm, or treatment for DME (performed at the discretion of the investigator).
The cumulative probability of meeting an increase in OCT CPT of at least 50 μm from baseline and a CPT of at least 300 μm, or treatment for DME was 27% (95% confidence interval (CI): 14%, 38%) by 1 year and 38% (95% CI: 23%, 50%) by 2 years.
Although subclinical DME may be uncommon, this study suggests that between approximately one-quarter and one-half of eyes with subclinical DME will progress to more definite thickening or be judged to need treatment for DME within 2 years after its identification.
EYETUBE: Synergetics 29-gauge Duel Chandelier Light
05/29/2012 -A video tutorial of how to untilize chandelier lighting to improve surgical outcomes. Continue reading here.
The Advent of Chandelier Illumination in Vitreoretinal Surgery
Chandelier illumination use has steadily increased in the past 5 years due to increased availability, improved technology, brighter lighting systems, and ease of use. Several companies have invested time and money in the research and development of these systems to assist vitreoretinal surgeons. With these trends in mind, we decided to explore the use of these systems.
Our esteemed panel consists of Vit-Buckle Society Executive Board members Derek Kunimoto, MD, JD; Rohit Ross Lakhanpal, MD, FACS; Audina Berrocal, MD; Charles W. Mango, MD; Andrew Moshfeghi, MD, MBA; John Kitchens, MD; and VBS members Jonathan Prenner, MD; Brandon Busbee, MD; Charles Wykoff, MD, PhD; and Jorge A. Fortun, MD. Continue reading here.
EYETUBE: Extreme Buckling
John Kitchens, MD, offers guidance for starting with scleral buckling procedures. Continue reading here.
Moving Beyond the "Wow Factor"
Retinal images captured by the Optos 200Tx can elevate patient care. Continue reading here.
Implementation of Ultra-Widefield Retina Imaging
Doctors familiar with the technology discuss practice logistics. Continue reading here.
As a group, retina specialists like to live on the edge and do daring things. I am no exception, and I like to think that this daring is evident in my approach to scleral buckling—or, as I call it, extreme buckling. To follow is a primer on how to transition to becoming an extreme buckler. Continue reading here.
Rule No. 1: Start Out Easy...
Applying Ultra-Widefield Angiography in Diabetes and Other Inflammatory Diseases
Exploring how the technology can be used to manage patients with macular edema, uveitis and retinitis. Continue reading here.
SURGICAL UPDATES: The Next Generation Machines for Modern Vitrectomy
08/01/2011 -At the 2011 Association for Research and Vision in Ophthalmology (ARVO) meeting, the Vit-Buckle Society met to discuss three current-generation vitrectomy machines. 2010 was a banner year for vitreoretinal surgical equipment. To help start a discussion about the surgical platforms, Christopher Riemann, MD; Derek Kunimoto, MD; and Jorge Fortun, MD, presented a quick summary of the Dutch Ophthalmic USA (Exeter, NH), Bausch + Lomb (Aliso Viejo, CA), and Alcon Laboratories, Inc. (Fort Worth, TX), systems, respectively (three lectures linked to EYETUBE.NET). Continue reading here.
Modified external needle drainage of subretinal fluid in the management of rhegmatogenous retinal detachment using a "guarded needle" approach
External needle drainage of subretinal fluid is a useful technique to assist with retinal detachment surgery. This technique provides the ability to directly visualize the removal of subretinal fluid in a controlled manner. The major difficulty in learning this technique is the potential for overpenetration with the needle. Using a "guarded needle" approach can reduce this risk and increase the adoption of this useful method. Continue reading here.
The vitreous trap: a simple, surgeon-controlled technique for obtaining undiluted vitreous and subretinal specimens during pars plana vitrectomy
02/01/2011 -A surgeons comment on vitreous tap techniques. Continue reading here.
EYETUBE: Trans-Scleral Surgery
01/17/2011 -The sclera offers many opportunities to advance surgical skills from a retina standpoint. John Kitchens, MD, presents several surgical techniques, including scleral tunnels, guarded needle drainage, and drainage of serous choroidals with needle aspiration.
Continue reading here.
The Uncharted Realm of the Retinal Periphery
Diagnostic imaging has played an increasing role in eye care in recent years. It seems like every time we turn around, retina specialists are being offered some new imaging device boasting an overwhelmingly powerful “Oh, wow!” factor. But precious and few are the devices that change the way we think about a disease or fundamentally alter clinical management. In this article, we will discuss a new technology that may accomplish these very things. Continue reading here.
SURGICAL UPDATES: Transscleral Surgery
01/01/2011 -I never thought much about the sclera during my residency.To me, it was just an obstacle between me andthe anterior or posterior chambers. It was only duringmy fellowship, when I was introduced to the conceptof scleral tunnels as an alternative to sutures for holding ascleral buckle in place, that I began to value the sclera.Since that time, I have practiced and learned a number oftechniques that use the sclera as a gateway, rather than anobstacle, to the subretinal and suprachoroidal spaces. Continue reading here.
SURGICAL UPDATES: Creating Quality Surgical Videos
02/01/2010 -Creating quality surgical videos involves more than just recording an interesting surgical case and uploading it to Eyetube.net, submitting it to the American Society of Retina Specialists (ASRS), or publishing it in a journal such as the British Journal of Ophthalmology. It is a process that involves the capturing of the highest quality of video and extends to adding quality finishing touches such as adding narration. In this article, I review the process that I use to create a surgical video. Along the way, I provide tips and techniques that can make the process easier. Continue reading here.
EYETUBE: Editing Surgical Videos with iMovie
12/18/2009 -Dr. John Kitchens presents a step-by-step tutorial for editing and producing surgical videos with iMovie software (Apple, Cupertino, CA). Continue reading here.
Triamcinolone acetonide preparations: impact of crystal size on in vitro behavior
To characterize the in vitro behavior of three preparations of triamcinolone acetonide (TA).
Three preparations of TA were mixed with Balanced Salt Solution Plus: commercially available TA (Kenalog 40, Bristol-Myers Squibb, Princeton, NJ), compounded preservative-free triamcinolone acetonide (PFTA, New England Compounding Center, Framingham, MA), and triamcinolone acetonide injectable suspension (TAIS, TRIESENCE, Alcon, Inc., Fort Worth, TX). We determined the mean number of crystalline aggregates per high-power deconvolution microscopy field, largest aggregate area, and spectroscopic photometric absorption.
Preservative-free triamcinolone acetonide had larger mean number of aggregates compared with TA (time 0 P = 0.002, 10 minutes P < 0.001) and TAIS (time 0 P < 0.001, 10 minutes P = 0.003). Aggregate size varied at both 0 and 10 minutes: TAIS > TA > PFTA. Spectroscopic photometric absorption decreased in direct correlation to aggregate size over time for all three preparations.
In vitro, PFTA in Balanced Salt Solution Plus had more aggregates of smaller size than either TA or TAIS. By contrast, TAIS had much larger aggregate size than both PFTA and TA, and this increased over time. These findings correlate with the clinical observations that PFTA and TA tend to disperse throughout the vitreous, whereas TAIS tends to conglomerate and gravitate toward the most dependent portion of the eye in a globular fashion.
Medrounds: Technology Update
03/03/2009 -Devices to make life easier for the eye care professional. Continue reading here.
Retinal breaks observed during pars plana vitrectomy
To quantitate the frequency and features of retinal breaks discovered at the time of vitrectomy and to evaluate the outcomes with prophylactic treatment.
A consecutive, single-surgeon, retrospective, observational case series from a two-year period.
Medical records were reviewed for all patients who underwent primary, standard, three-port pars plana vitrectomy (PPV) between January 1, 2000, and December 31, 2001. Intraoperative findings recorded included the number, location, and categorization of retinal breaks and their method of management. Postoperative features recorded included the presence or absence of a retinal detachment (RD).
There were 65 retinal breaks found in 48 (11.6%) of 415 eyes and included 30 (7.2%) eyes with definite breaks, nine (2.2%) with suspicious breaks, and nine (2.2%) with probably preexisting breaks. Breaks that were described as being large (n = 5) were more commonly associated with the right-hand sclerotomy (P = .041), although other categories of breaks were not. After surgery, the overall incidence of RD was 2.2% (nine of 415 eyes). The rate of RD among the 48 eyes with retinal breaks (of any category) was also 2.1% (one eye). All RDs in this series occurred more than three months after initial vitrectomy and, accordingly, were probably unrelated to retinal breaks that occurred during surgery.
Recognition of retinal breaks and intraoperative treatment with retinopexy and air-fluid exchange during vitrectomy reduces the postoperative risk of RD to that among eyes without observed intraoperative retinal breaks.
Indocyanine green-assisted internal limiting membrane peeling for macular holes: toxicity?
Indocyanine green (ICG) staining facilitates definitive internal limiting membrane (ILM) peeling during macular hole surgery (MHS), but might cause toxicity.
To determine if ICG to assist in ILM peeling has an effect on anatomic or visual results in MHS with ILM peeling.
Retrospective, comparative review including primary analysis of 173 cases undergoing MHS. Visual acuity >or=20/50,
The single operation hole closure rate was 87% with ICG versus 83% without ICG (P = 0.52). Postoperative median best-corrected visual acuity was 20/70 and 20/80 in the ICG and no ICG groups with median follow-up intervals of 8 and 9 months. The use of ICG was associated with a higher rate of
ICG usage during macular hole surgery was not associated with worse visual outcomes, suggesting possible toxic effects reported are not clinically significant. If the ILM cannot be peeled effectively, ICG should be considered a safe option.