The Setup of advanced VR course

E. Parikakis1 – A. Nikolakopoulos2

1 “Ophthalmiatreio” Eye Hospital, Athens, Greece2 “ G. Papanikolaou” Gen. Hospital ,Thessaloniki, Greece

The Setup of Advanced VR Course

Theory sessions

Surgical Wetlabs with modern vitrectomy units –microincisional surgery (23,25,27 gauge) –operating microscore & wide angle viewing systems

Practice in pig-eyes and Synthetic eye model (artificial eye)

Practice in computerized training simulator

Retina Dry labs

Step by step wetlab vitrectomy

Fluidics and observation systems Sclerotomies (trocars) and fixation of infusion line Removal of central vitreous (~ hemmorrhage)

(Indentation) & removal of peripheral vitreous Injection of PFCL and exchage to air / BSS P. P. Lensectomy

Removal of lens fragments ± PFCL Management of dislocated IOLs Silicone oil in and out Removal of IOFB (trauma) Struggling with RD (including scleral buckle) ILM removal (& artificial eyes)

Step by step training in Simulator

Posterior vitreous detachment induction Epiretinal membrane removal ILM peeling Endolaser training Forceps / vitrector training

Supervised practice on virtual reality simulator gives realistic hand on surgical experience

Allows unlimited practice and repetition There are customized difficulty levels (training

modules for the beginner and advanced modules for the expert)

1. Vitrectomy Units - IOP Control

Increase IOP to control hemorrhage Decrease IOP in retina ischaemia, glaucoma Some problems in rapid IOP control, open

sclerotomies, aspiration, bottle change

1.1. GravitGravityy system system (bottle height)

2. VGFI System (vented gas forced infusion)

2. 2. VGFI System VGFI System (vented gas forced infusion)

AlconAlcon

2500cpm Cut Rate

2500

Wet Ant Prop Vac

VIT: Proportional Vacuum32

BSS

Air

Applied pressure=32mmHg

IOP = ? mmHg

Pressure Drop?

Flow variationsFlow variations

““HypotonyHypotony””

Infusion bottle in certain height Pressing the footpetal to raise the pressure to air >

raise pressure to bottle > raise pressure to eye

3. Compensated IOP3. 3. Compensated IOPCompensated IOP

BSS

True IOP = 30 (±2) mmHg

IOP Setpoint = 30mmHg

T(sec)

P(mmHg)

PCassette (inside infusion chamber)

PIOP (inside the eye)

Flow Compensated IOP

AlconLuxOR LX3

&Q-VUE

Modern microscope technology & iOCT, 3D

Leica M844 F40 –(3D)

Haag-Streit Hi-R 900A &

iOCT

ZeissLumera 700

& Rescan 700

TrueVision

Stereoscopic high-definition visualization system that display the surgical field of view in real time on a

3D flat panel display in the OR.

Wide angle viewing systems (WAVs)

• WAVs are necessary for fundus visualization - are based on the indirect ophthalmoscopic principle.

• Modern WAVs enhance surgeons’ manipulative abilities by providing a wide field of view and H-R fundus images.

Zeiss Resight 700

Haag-Streit EIBOS 2

Oculus Biom Ready

Wetlab Vitrectomy Tips

Prepare your case and make yourself comfortable (chair, fix your microscope, lower magnification = greater depth of field, lay your instruments down with order, check the vitrectomy unit)

Refocus as often as necessary Soft pig-eyes globes can be restored with saline

injection Pin the globe down for stability If the visibility is poor, you can scrap the

epithelium to improve it (or 15% dextran) Remember that vitrectomy is a multitasking

procedure (it involves both feet and hands, vision and hearing)

Before leave, make sure you have clean everything, so the next person will find a nice and clean working place

The Setup of advanced VR course

E. Parikakis – A. Nikolakopoulos

Thank you !

Το σύστημα έγχυσης ελέγχει με αισθητήρες τηνείσοδο από την έγχυση και την έξοδο από τηναναρρόφηση και ρυθμίζει αυτόματα

Δυνατότητα για το χειρουργό να καθορίζει την IOP «Set and Forget »

Σταθερές ενδοφθάλμιες πιέσεις, όχι υποτονίες

Επιτρέπει χειρουργείο με χαμηλές πιέσεις

Σταθερότητα σε αλλαγή μποτίλιας«On-fly Bottle Change»

3. Integrated pressurized infusion– «πραγματικός» έλεγχος IOP

IOP Control

• IOP control maintains pressure in the eye to + 2 mmHg of what is at console

• Constellation® infusion system automatically adjusts for the infusion tubing and cannula pressure drop which occurs when fluid is flowing through the cannula.

• Compensates for the Infusion Cannula Pressure Drop is in Real Time

• Provides a Constant IOP during Surgery

Σύγχρονη τεχνολογία- Εξέλιξη των probes

Initial 25 ga instruments excessively flexibleDifficult to trim peripheral gel and perform peripheral endoLASERAs instumentation became more rigid →additional surgical indications became possible25- & 23 ga cutter mouth is closer to the end →more controlled segmentation (multifunctionality)

EndoLASER, Perflurocarbon liquidsWide-angle viewing systems, Improved illuminating systems (Xenon) 25g & 23g transconjunctival sutureless microincision vitrectomy (MIVS)

High speed vitrectomy probe of 7.500 cpm with duty cycle control“True” IOP control – pressurized infusion, Valved cannula systems 27+G Vitrectomy