背景::\"Achoo\"是与打喷嚏相关的声音。一个喷嚏,在极少数情况下,会导致Valsalva视网膜病变.通常,小出血会随着时间的推移而被吸收。但是如果出血持续更长的时间,它会导致血液去血红蛋白化,从而对光感受器造成损害。如果这样的损伤发生在黄斑上,它会导致不可逆的视力丧失。因此,在这种情况下,需要迅速和细致的治疗。这里描述了一个这样的案例,一位女士突然打喷嚏,一个月后呈现给我们。在黄斑上注意到大的亚内界膜(ILM)出血。因此,建议采用ILM剥离并引流血液的玻璃体切除术。手术后一个月,她恢复了20/40的视力。
目的:本视频强调了ILM下出血的诊断以及在现代微切口玻璃体视网膜手术中可以引流ILM下出血的技术。
UNASSIGNED:在这种情况下,一个关键方面是区分亚ILM和亚玻璃样出血。视频中描述了成像上的细微区别点。在亚ILM出血的情况下,进行核心玻璃体切除术后最重要的手术步骤是良好的玻璃体后脱离(PVD)诱导.之后,在精细环和ILM剥离钳的帮助下进行ILM剥离。使用比例真空和抽吸交替从刀具,出血被移位并排出。该步骤可以防止对下面的视网膜组织的损伤。黄斑出血完全清除后,空气-流体交换完成。
结论:教学要点包括:1.亚ILM出血的诊断标记物;2.亚ILM出血病例的PVD诱导方法;3.使用比例真空和切割器的抽吸功能引流亚ILM出血的技术。
UNASSIGNED:https://youtu。是/hBhfLDy9o-Y.
BACKGROUND: : \"Achoo\" is the sound that is correlated with sneezing. A sneeze, in rare occasions, it can cause Valsalva retinopathy. Usually, small bleeding gets absorbed with time. But if the haemorrhage stays for a longer period of time, it can lead to de-hemoglobinization of blood which can cause damage to the photoreceptors. If such a damage occurs over the macula, it can cause irreversible visual loss. Hence, prompt and meticulous treatment is indicated in such cases. One such case is described here where a lady suffered from a sudden bout of sneezing and presented to us after a month later. A large sub-internal limiting membrane (ILM) bleed was noted over the macula. Hence a vitrectomy with ILM peeling with drainage of blood was advised. She recovered 20/40 visual acuity one month following surgery.
OBJECTIVE: This video emphasizes on diagnosis of sub-ILM hemorrhage and the technique in which the sub-ILM bleed can be drained in the modern era of microincision vitreoretinal surgeries.
UNASSIGNED: A key aspect in such cases is to distinguish sub-ILM from sub-hyaloid bleed. Subtle differentiating points on imaging are described in the video. In cases of sub-ILM hemorrhage, the most important surgical step after performing a core vitrectomy is a good posterior vitreous detachment (PVD) induction. After that, ILM peeling is carried out with the help of finesse loop and ILM peeling forceps. Using proportional vacuum and aspiration alternatively from the cutter, the hemorrhage is displaced and drained. This step can prevent damage to the underlying retinal tissue. After the macula hemorrhage is completely cleared, an air-fluid exchange is done.
CONCLUSIONS: Teaching points include: 1. Diagnostic markers for sub-ILM hemorrhage; 2.The method of PVD induction in cases of Sub ILM hemorrhage; and 3.Technique of drainage of sub-ILM hemorrhage using proportional vacuum and aspiration function of the cutter.
UNASSIGNED: https://youtu.be/hBhfLDy9o-Y.