10.
Italian Style to Color the Eye
Cesare Forlini, M. Forlini, A. Aversano, P. Rossini (Ravenna)
Aim of this presentation is to show a new pharmacological product introduced for the vitreoretinal
surgery and two surgical techniques routinely used for the macular surgery.
The introduction of Triamcinolone acetonide in the vitreoretinal surgery allows to perform a
more complete and radical vitrectomy, thank to its capability to link and show the vitreous fibrils.
Morevover, it links the posterior hyaloid and the epiretinal membranes, facilitating their
removal.
IVT® (BIOOS, Italy) is a new micronized Triamcinolone Acetonide in sterile syringe approved for
intraocular surgical use. It is a carbopolimer suspension containing crystals with an average
diameter of 30 microns. We show the use of this suspension during the common manoeuvres
performed during the common vitreoretinal surgery.
The advantages of this new molecole are:
– Uniform and complete opacification
– Lower dosage
– Lack of adverse effects
– Lack of systemic effects
– Safety of use
– Guaranteed sterility
– Not toxic for retinal or other tissues.
Perfluorocarbon liquids (PFCL) are heavier-than-water liquids introduced in the middle ’80 years by Dr. Stanley Chang to
flatten intraoperatively the retina during the vitreoretinal surgery for retinal detachment. The Indocyanine Green (ICG) is a
dye used in vitreoretinal surgery to stain the internal limiting membrane (ILM). We show the combined use of PFCL and ICG
to peel the ILM in case of vitrectomy for retinal detachment.
After put the PFCL on the posterior pole to flatten the retina, the long-cannula is positioned into the PFCL buble, very near
to the retinal surface and the ICG is injected. This allows the dye goes directly under the PFCL buble (pushed by the weight
of the liquid) and to stain the ILM. Then it is possible easily to perform the ILM peeling. The described technique avoids also
the ICG passes into the subretinal space, because the dye is injected between the PFCL and the retinal surface, without dispersion
in the vitreous chamber.
Finally, a combined use of IVT® and ICG is showed. Because of well known tossic effects produced by ICG in the retinal pigment
epithelium (RPE), we inject the IVT® on the hole, before the staining, to protect the inner layers of the retina. After
closing the infusion, a little amount of IVT® in put on the macular hole and then, the ICG is injected. Opened the infusion line
the ICG in excess is removed and it is possible to observe that the hole is not stained.
In conclusion, the combined use of IVT®, PFCL, ICG, allows the vitreoretinal surgeon more radical and certain surgical
manoeuvres.
Disclosure: ALL THE AUTHORS HAVE NOT FINANCIAL INTERESTS.