Surgical Videos

These are edited videos showing the highlights of different vitreoretinal surgeries.

Vitrectomy for Recurrent Vitreous Hemorrhage
Diabetic Tractional Retinal Detachment

62 year old man with recurrent vitreous hemorrhages from the traction around the macula and adjacent to the optic nerve. This video shows removal of the blood, release of the vitreoretinal traction, removal of the scar tissue and then laser. An air bubble was used at the conclusion of the case. The patient did very well and regained nearly normal vision within about a month of surgery.

Vitrectomy for complex retinal detachment
Subretinal Silicone Oil

56 year old woman has had several retinal detachment surgeries locally. She noticed after the last surgery that the vision did not get better. She has a macular hole, large posterior retinal hole and subretinal silicone oil. The video shows removal of the silicone oil from the eye and then a retinectomy (cutting of the retina) to remove the subretinal oil. The retina is reattached with perfluoron, laser, and then silicone oil is placed back into the eye.

Vitrectomy for retinal detachment
23 gauge

This 67 year old woman presented with acute shadow and vision loss in her left eye. She had previous retinal detachment repair in the right eye in 2005 by me. The left eye had a temporal retinal detachment with retinal holes and lattice degeneration at 12, 1, 4, and 6. I drained the subretinal fluid through the peripheral holes. I did NOT use perfluoron nor did I create a posterior retinotomy to reattach the retina. Her vision was back to baseline for her within about 2 months of the surgery.

Vitrectomy for Retinal Detachment
and Vitreous Hemorrhage

This 64 year-old man experienced the sudden onset of many floaters. They became so dense that he lost most of his vision. By the time he came in to the office he was found to have a large amount of blood in the eye that obscured all view of the retina. An ultrasound showed the retina had detached. A vitrectomy was planned to remove the blood to visualize the retina for repair. Although vitrectomy does promote cataract formation, there was no other reliable way to repair the retina in this case. No scleral buckle was required because the single superior retinal break was sealed with laser during vitrectomy and the retina was held in position with a gas bubble.

Vitrectomy for retinal detachment
with Scleral Buckle

This 65 year-old man became aware of new dot-like floaters several weeks before coming in for evaluation and only recently noted loss of side-vision in his left eye. He had a mild cataract, but could still see 20/20. He had multiple retinal tears both superiorly and inferiorly in the retina and had two separate areas of retinal detachment. Because he did not have a significant cataract and had multiple retinal breaks, i chose to repair his retina with an encircling scleral buckle. By avoiding vitrectomy I reduced the risk of cataract formation. This retinal detachment was too far advanced for laser demarcation. The multiple inferior breaks made him a poor candidate for office pneumatic retinopexy. A segmental scleral buckle would not have supported all of the breaks and would less support to prevent additional breaks from developing in the future. See www.scottpautlermd.com for more information.

Macular Pucker Surgery
25 Gauge High Def

This 65 year old woman has had decreasing vision for 12 months from a macular pucker. The vision was 20/50 before surgery, 20/60 one day after surgery and 20/25 1 week after surgery. Before and after photos and OCT scans are included in the video.

Floater Vitrectomy
25 Gauge High Def

This 65 year old woman has had floaters and visio problems for 7 years. The surgical video shows the vitreous clumps and opacities directly behind the intraocular lens. She was clear and happy and visually better the first day after surgery.

Retinal Detachment - Multiple Tears
Scleral Buckle and Vitrectomy

THIS SURGERY SHOWS SOME BLOOD. This 50 year old man had 4 days of vision loss. He had a total retinal detachment with multiple retinal breaks and lattice degeneration. He is a -12.00 myope with a dense cataract. The surgery shows retinal detachment repair with a scleral buckle (42 band and 70 sleeve) and a vitrectomy (23 gauge). Laser is used at the time of surgery and 25 percent sulfer hexafluoride gas is used as endotamponade. The surgery is done under general anesthesia. Marcaine (a long acting anesthetic) was irrigated around the eye for post-operative pain. The marcaine lasts about 8 hours. Subsequently the patient had moderate pain for about 2 days that was controlled with non-prescription pain medicines. After retinal detachment surgery, the patient positioned for a week, initially face down and then side to side.

Macular Pucker Surgery
25 Gauge High Def

This 65 year old woman has had decreasing vision for 6 months from a macular pucker. The visual acuity is 20/200. The patient had cataract surgery 6 months ago and the vision is still hazy and distorted from the macular pucker. Vision improved to 20/30 6 months after surgery

Vitrectomy for 20/400 Macular Pucker
25 Gauge High Def

This 60 year old man with 20/400 macular pucker and vision loss over about a year. Vision was 20/80 at 1 month follow-up visit. High definition video - very thick macular pucker (epiretinal membrane).

Dislocated IOL
Trans-scleral Fixation

This is a novel technique to secure a dislocated intraocular lens using a 9-0 prolene suture that allows the suture and the knot to both be completely buried at the end of the surgery without the need to make a scleral tunnel.

Macular Hole Surgery
No Internal Limiting Membrane Peel

This patient had a two month history of vision loss from a macular hole. The pre-operative OCT scan showed a stage II macular hole with a diameter of about 250 microns. The scan did not show a taught internal limiting membrane. This surgery is done with a short acting sulfer hexafluoride gas and no internal limiting membrane peel. The patient positioned for a week after surgery (Strict for 3 days). The hole closed and the vision has improved to 20/30 at 2 months.

Diabetic Vitreous Hemorrhage
18 Months Old - Dense

65 Year Old woman with vision loss for almost 2 years. Her vision was light perception when she presented. Her fellow eye had mild proliferative diabetic retinopathy. This eye had a normal ultrasound (except for the vitreous hemorrhage). Her cataract was removed about 2 weeks prior to this surgery. Diabetic vitrectomies have slightly better outcomes if done subsequent to cataract surgery. This video shows the dense vitreous hemorrhage looks yellow white.

Removal 2 Dislocated IOLs
Scleral Incision

This 80 year old man had a dislocated, in-the-bag, intraocular lens. He had a previous pars plana vitrectomy. His cataract surgeon attempted an iris suture intraocular lens as a replacement and that fell into the vitreous cavity. Then, at the same sitting, the surgeon placed an anterior chamber intraocular lens. About 1 week later, the second posterior chamber intraocular lens moved forward and wedged itself in between the iris and the haptic of the anterior chamber intraocular lens. The patient then developed corneal edema. After removing these two lenses, the corneal edema cleared in about one month.

In-the-bag Dislocated IOL
Scleral Suture

80 year old woman who had a lens exchange for an anterior chamber intraocular lens 3 years ago in the fellow eye and now had chronic cystoid macular edema controlled with every 6 months posterior subtenon's Kenalog. The intraocular lens dislocated in the right eye about 1 month ago and the vision is hazy. This procedure is an excellent option for dislocated silicone plate intraocular lenses because the fixation hole in the intraocular lens can be used to suture the lens to the sclera.

Macular Hole Surgery
Internal Limiting Membrane Peel - No Stain

Macular hole surgery in a patient with a stage 2 macular hole. The internal limiting membrane is peeled. A short acting gas was used (sulfur hexafluoride) and vision was 20/50 1 week after surgery. This surgery was done 1 month ago. Vision at 1 month visit was 20/40.

Vitrectomy Vitreous Opacities
Floaters

70 year old man with significantly compromised visual function for 1.5 years from a vitreous opacity in his better 20/16 eye. Video shows 25 gauge vitrectomy in high definition. Over 99 percent of symptomatic vitreous floaters will improve without any treatment within 6 to 12 months. There are significant risks to surgery for vitreous floaters which have to be weighed against the benefits. Vitrectomy almost always causes a worsening of a cataract, but since this patient had already had cataract surgery that was not a concern.

Lens Fragments and Dislocated IOL
Iris Fixation

This patient had cataract surgery and some of the fragments from the surgery dropped into the vitreous. They are removed and then the intra-ocular lens, which is not stable, is sutured to the iris for stability.

Diabetic Vitreous Hemorrhage
25 gauge vitrectomy

60 Year old African american female was referred with 9 months of vision loss from a vitreous hemorrhage. She noticed a drop in vision 3 months ago where the vision seemed to go dark. The pre-operative ultrasound suggested a possible combined rhegmatogenous – tractional retinal detachment. There was also a dense cataract present. The video shows the surgery where the cataract is removed with a fragmatome leaving the anterior capsule intact. Toward the end of the surgery, when the macular membranes are being trimmed, the vitrectomy cutter clearly becomes dull and unable to cut and remove the membranes. Switching to a new vitrectomy probe allows safe completion of the surgery. This video illustrates that vitrectomy cutters can dull and recognizing this, switching to a new probe can allow for safe completion of surgery in select difficult cases.

Choroidal Hemorrhage Drainage
Ligation of Baerveldt Tube

83 year old man had macular hole surgery in 1996 and his visual acuity improved to 20/50. 2 months prior to this video he had a Baerveldt Implant in his left eye and his intraocular pressure was low (less than 6). He developed a choroidal hemorrhage 3 weeks prior to this video. By the time of the surgery, the blood had liquified and drained easily. The video is sped up to double speed during the drainage of the choroidal hemorrhage parts. The patient regained 20/100 vision at the time I am posting this which is one month post-operatively. Even thought the drainage tube was ligated, his intraocular pressure was still low at about 6 mmHg after this surgery.

Cyclodialysis Cleft Closure
for Hypotony Maculopathy

This 79 year old man had a cyclodialysis cleft and, despite has advanced age, vision loss from hypotony maculopathy. His intraocular pressure before the procedure was 6 mmHg. He had been treated for 4 months with drops and twice with cryotherapy to the cleft. After the procedure his intraocular pressure increased to 26 mmHg and his vision improved from 20/200 to 20/60.

Retinal Detachment with PVR
360 degree retinectomy

This patient had 3 previous retinal detachment surgeries and the most recent one involved a 180 degree inferior retinectomy and laser. These were all done elsewhere. This video shows a complex retinal detachment repair. Initially the hazy intraocular lens is removed. Next a macular pucker is removed and the anterior proliferative vitreoretinopathy (scar tissue) is cut. Even with those two maneuvers the retina does not reattach. A 360 degree retinectomy is performed (cutting the retina 360 degrees in the periphery) and this allows the retina to be attached with perfluoron, laser and subsequent silicone oil.

Macular Hole Surgery
with ILM peel

Re-operation for a failed macular hole sugery. In this surgery the internal limiting membrane is peeled using no stain. The high definition video shows the maneuver nicely. This 75 year old female patient recovered vision from 20/200 to 20/30 about 3 monhs after the surgery.

Retinal Detachment
Giant Retinal Tear - Perfluoron and Silicone Oil

This eye has a 3 clock hour retinal tear and nasal, relatively small, retinal detachment. Retinal tears that are 3 clock hours or bigger are considered "giant" retinal tears. The techniques to reattach these retinas are slightly different from those used in eyes without giant retinal tears. Perfluoron is used to flatten the retina initially. The Perfluoron is a heavier than water liquid. It rolls the retina back into its natural position and smooths out the area with the giant tear. Since this was a relatively small and very anterior (front of the eye) giant tear, I used air and gas to flatten the retina at the end of the surgery. In cases of larger giant retinal tears or more posterior giant retinal tears, silicone oil is often more appropriate.

Retinal Detachment
Scleral Buckle - Segmental

This patient had a retinal detachment with symptoms of a creeping shadow for about a week. The examination showed that some components of the retinal detachment were old. Because of the configuration of the detachment, with a single break at 7:00, it was decided to reattach the retina with a segmental scleral buckle.

Ahmed Valve
with Scleral Buckle Revision

This patient had narrow / angle closure glaucoma and a corneal graft. She has had 10 previous surgeries. In order to make room for the Ahmed Valve plate, a piece of the scleral buckle is removed.

Retinal Detachment
Retinopathy of Prematurity - Stage IV

Lens sparing vitrectomy. This infant had 3 laser treatments and developed a worsening nasal retinal detachment which was threatening her macula. She underwent a lens sparing 25 gauge vitrectomy with a temporal approach.

Sub-Macular Surgery
Removal Sub Macular Scar

Removal of a Subretinal Neovascular Membrane in an eye with Ocular Histoplasmosis Syndrome. This video is about 7 minutes long and shows a 20 gauge vitrectomy. The patient has 20/400 visual acuity from a subretinal neovascular membrane. He has had previous laser for ocular histoplasmosis syndrome

Retinal Detachment with Macular Hole
Scleral Buckle and Vitrectomy

Vitrectomy and scleral buckle for retinal detachment and macular hole. This 56 year old woman has had decreasing vision for 1 week from a retinal detachment with a macular hole. The visual acuity is 20/800. This video shows some blood because of the extensive surgery. Vision ultimately improved to 20/40 with glasses.

Macular Hole
ILM Peel with ICG Stain

Macular hole surgery with indocyanine green assisted internal limiting membrane peel. This 73 year old woman had a macular hole in her right eye for 3 years. She initially declined surgery for the macular hole. She had trouble with her left eye and had treatment of retinal tears 3 months ago. Her left eye did fine, but now, out of concern for the future health of her two eyes, she elected to have surgery to close the macular hole in her right eye. The visual acuity is 20/200 and this is a stage IV macular hole.

Lens Fragments
Vitrectomy

Removal of retained lens fragments and insertion of secondary anterior chamber intraocular lens. This 70 year old woman had cataract surgery 2 days previously. At the time of surgery some of the cataract lens dislocated into the vitreous cavity. The operating surgeon chose not to insert an intraocular lens at the time of the cataract surgery. This video shows the removal of the lens fragments and the insertion of the secondary intraocular lens.

Dislocated IOL
Capture Optic in Capsulotomy

Macular pucker surgery using 25 gauge small incision "no stitch" system and repositioning of decentered intraocular lens, This 67 year old white male has noticed decreased vision in his left eye for one year. He had a cataract surgery one year ago. His vision did not improve. It looked like he had a thumbprint in front of his lens. Then aout six months ago he noticed his vision becoming more foggy. He is diabetic for 18 years and has high cholesterol, high blood pressure and heart disease. He was recently diagnosed with glaucoma and started on a pressure lowering eye drop. His visual acuity on presentaiton was 20/50 in each eye. His intraocular lens was displaced superiorly in each eye. In the left eye the intraocular lens was displaced enough so that the edge of the lens was at the visual axis. His left eye also had a macular pucker. He also had optic nerve cupping in each eye.

Retinal Detachment Subretinal Fibrosis
Removal Subretinal Fibrosis

This 80 year old man had 2 retinal detachment surgeries elsewhere. He was referred one month ago and had surgery by Dr. Cohen for a retinal detachment with subretinal and pre-retinal silicone oil and extensive preretinal fibrosis. The retina was reattached and then one month later he developed a limited retinal detachment. Interestingly, the only part of the retina that was not detached at the initial surgery was the part that detached.

Ahmed Valve
Neovascular Glaucoma

Placement of an Ahmed valve with the drainage tube in the anterior chamber in an eye with unconrolled neovascular glaucoma. This 81 year old man has been managed for 3 months with laser, drops and oral medications for neovascular glaucoma induced by a central retinal vein occlusion. His intraocular pressure is between 30 and 40 despite maximal medical therapy. He also has a history of heart failure. Some of his glaucoma medications cannot be continued without risk of exacerbating his heart disease. His visual acuity is 20/160 in this eye. His other eye is 20/60 because of a macular pucker.

Retinal Detachment
Scleral Buckle and Vitrectomy

Scleral Buckle and Vitrectomy for Retinal Detachment, This 65 year old woman had retinal detachment with decrease visual acuity for 1 week.. The visual acuity is 20/80. This video shows some blood because of the extensive surgery. The scleral buckle part of the surgery at the beginning of the surgery has some blood.