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Full Macular Translocation in Exsudative Age Related Macular Degeneration

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Full Macular Translocation in Exsudative Age Related Macular Degeneration

DOI: 10.3207/0663207832

Core vitrectomy, posterior vitreous separation if not yet present, vitreous base shaving, usually those eye are pseudophakic otherwise the natural  lens can be shifted anteriorly by anterior chamber drainage, so that the vitreous base is accessible without damage to the lens. BSS injection is used to detach the retina, first transretinally to create a retinal bleb of sufficient size to allow further BSS injection transretinally via a 30 or 27 gauge cannula. As long as the peripheral retina is without break and no leak exists from the subretinal to the vitreous space, the retina will continue to detach until complete retinal detachment. Then the vitreous cavity will be reestablished  by intravitreal PFCL injection in conjunction with a small peripheral retinectomy. Once two third of the vitreous cavity is filled with PFCL the peripheral retina is being cut and removed together with the vitreous base using a cutter. After aspiration of the PFCL the submacular space is accessible and the CNV can be removed. Eventual bleeding stops either by itself or requires cautery. The central retina is reattached by semifluorinated fluorocarbon which has a specific gravity of 1.3 and facilitates to slide and rotate the retina around the optic disc as much as needed. In this film the surgeon is positioned over the head, thus the superior fundus is represented in the lower part of the picture. Eventually the macula is sufficiently distant from the choroidal defect, which itself is located in the inferior temporal arcade (superior part of the picture). Finally PFCL is added to the already existing semiflurorinated fluororcarbon to completely reattach the retina, laser the edge of the retina 360 and exchange the PFCL against silicone oil.  

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Author: Bernd Kirchhof
Submitted: 28/07/2009
Published: 14/08/2009
Views: 6529

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