Disclosures. How small?

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1 Disclosures Still have not changed. Surgical Panel Sunil K. Srivastava, MD Cleveland, OH Lets get these few comments out of the way How small? Do you stain for ILM peels? And if so what do you use Do you look down upon those who don t agree with your stain? How many 20 gauge cases have you done in the past 1 year? Do you think you will use 27 gauge? Whats made a bigger difference small gauge or valved cannulas? 1

2 I like fast cutters and I can not lie.. The faster the better 5000 cuts What about 7500 cutter? Utility of increased speed? Intra-op OCT? Is this the future? Are we just wasting our time? ioct: Microscope Integrated OCT Systems Current Systems: /Cleveland Clinic Duke University Carl Zeiss Meditec External Cirrus System Rescan 700 Haag-Streit ioct and Moller- Wedel System Bioptigen prototype Ehlers JP, Kaiser PK, Srivastava SK, BJO 2014, in press 2

3 Ehlers JP, Kaiser PK, Srivastava SK, BJO 2014, in press Ehlers JP, Kaiser PK, Srivastava SK, BJO 2014, in press How do you repair Phakic, 55 year old,

4 Panel? Wide field viewing for scleral buckling Nam, K et al, Retina 2013 Navrocki et al Ophthalmic Surg Laser 2008 Aras et al Ophthalmologica 2012 Video What about this? 4

5 25 year old PDR, was driving until last week 25 year old was driving until last week Questions for panel Viscodissection When? Lens? Pre-op avastin? What technique? 5

6 65 year old physician Earlier in the day underwent chalazion excision Surgical Management of Chalazion complications Sunil K. Srivastava, MD During injection of anesthesia notes pain with decreased vision Cornea opaque, IOP 75 AC tap performed IOP normalizes DFE performed retinal hole with superior detachment Sent to Cole for further managment Thoughts Intravitreal injection of lidocaine Unknown amount Retinal detachment Retina appears opaque Small break Need for PPV? Toxicity of lidocaine Intravitreal abx? 6

7 Surgery 7

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9 4 weeks later 9

10 More injection related injuries 10

11 Case Presentation 57 year old male presents with pain in his eye Earlier in the day periocular steroid for post-op CME Accidental injection into the vitreous A lot of the injection ended up in the eye 11

12 Thoughts? 12

13 But wait there is more. 13

14 Case Presentation 85 year old female referred for decreased vision OD 1 week prior underwent attempted cataract surgery Scheduled for topical, during case, patient was moving, thus peribulbar block performed Case Presentation That night patient with severe pain POD #1 Vision was Hand motions Vitreous hemorrhage noted Patient told, possible complication with block Procedure aborted, as patient was still moving Case Presentation VA LP IOP 6, 14 OS SLE lid bruising, mild conj injection, cataract DFE dense blood 14

15 Retrobulbar blocks Case Presentation Do you do them? Vitreous Hemorrhage, probably posterior rupture site Plan PPV, but wait a few days for posterior rupture site to seal Just one of those days Case Presentation 65 year old male with decreased vision since discharge from hospital Treated for Nocardia brain infection Poor vision OU 15

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