Dear Friends
The Retina Surgeon blog has now moved to the Society for Clinical Ophthalmology website:
http://www.clinical-ophthalmology.com/index.php?option=com_content&view=category&id=82&Itemid=84
OR go to http://www.clinical-ophthalmology.com/
Click on Practitioners
Click on Members Forum in the left frame
Click on Retina Surgery on the submenu.
Direct video upload is not available at the moment, but will be online within the next few days. For now if you could please email me your video either by email to somprasad@gmail.com or by clicking on the mail link on the site, I will get it uploaded.
You can start posting text comments immediately.
Best wishes
Som
Sunday 28 June 2009
Friday 19 June 2009
Moving base
Dear All,
Thanks for your support with this blog, it has been a great experience that over 30 colleagues have been following this blog within a few days of starting it, and visitors have grown steadily after that. Your interest has inspired me to seek a wider platform and this blog will soon be moving to the website of the Society for Clinical Ophthalmology.
http://www.clinical-ophthalmology.com/
Please visit this site, and consider joining, it is a vibrant forum, and I believe that joining forces with this Society, will increase the relevance of this blog, and enable better interaction.
Do join, and contribute, the new site will (as we develop it) allow memebers to not only upload comments, but start thier own discussions and upload thier own videos for comment and discussion.
See you at the Society for Clinical ophthalmology website.....
Au Revoir
Som
S Prasad
Thanks for your support with this blog, it has been a great experience that over 30 colleagues have been following this blog within a few days of starting it, and visitors have grown steadily after that. Your interest has inspired me to seek a wider platform and this blog will soon be moving to the website of the Society for Clinical Ophthalmology.
http://www.clinical-ophthalmology.com/
Please visit this site, and consider joining, it is a vibrant forum, and I believe that joining forces with this Society, will increase the relevance of this blog, and enable better interaction.
Do join, and contribute, the new site will (as we develop it) allow memebers to not only upload comments, but start thier own discussions and upload thier own videos for comment and discussion.
See you at the Society for Clinical ophthalmology website.....
Au Revoir
Som
S Prasad
Saturday 2 May 2009
Video Setup
This question is often asked, what is the best way to get high quality ophthalmic surgical video?
1. Firstly, always leave the recorder running, as interesting things happen suddenly, and turning on the recorder after that mises the key event! These days with large capacity hard disk recorders, I leave it running through the whole operating list - and if nothing of interest occurred, then one can simply wipe the track andrerecord over it the next day!
2. Camera- currently the Sony 3 chip (EXWAVE HAD) cameras still seem to be the best. There are a few new HD cameras out, which are both very expensive, and till most venues get facilities to project HD, maynot be worth the investment
3. Link, Firewire from camera direct to recording device is best - the feed should go straight to the recorder & output from recorder to your TV monitor (not the other way round), A Composite video link, probably delivers similar quality (if your camera doesn't have firewire output)
4. Recorder - I am currently using a hard disk recorder from Datavision. This has 250GB removable drives, so you can record a few days surgery on on disk, take it out - take it to your office/home where you can copy files to PC/Mac and select the bits you want to keep. The rest are deleted. If you have a couple of spare disks, then you can be recording on the next one, whilst sorting the content of the first - so a sort of cycle goes on. Beware of recording direct to DVD, as this is already compressed to mpeg, and whilst output looks good, once you have edited (and sometimes redited more than once), there is loss of quality - the editing software basically tries to decompress the footage, and once you have edited it, recompress it, so every editing cycle has a depreciating effect on quality. Also some hard disk recorders actually compress to mpeg as they record (The Sony medical grade hard disk recorder records as mpeg), what you want is a recorder which records as a native DV stream (Datavision does that) or a relatively lossless format such as AVI - great for mac users as they are already set up to handle DV, but PC users (like me!) can still access the quality if they have the correct software - I use Adobe Premiere CS4, which allows me to import DV files directly and renders them well after editing, although if I play these DV files directly (say through Windows Media Player), the quality is rubish! But once imported into Adobe Premiere - quality is great! Codecs are a dark art which I do not fully understand - but I am here merely trying to explain what works for me (and maybe will for you).
5. Software - If you have an academic connection (Hony Lecturer, whatever), or even a child in full time education, you maybe able to get software on educational prices, which are much cheaper than market rates. I am told (unconfirmed) that Apple UK, if you ring them and say you are a NHS doc who teaches medical students, will give you a discount upto 15% - I haven't tried this being a pC use, but for some of you that may be worth trying.
6. Archiving - this is the biggest problem - Video files are huge - an if You have yaers of them, then you need terabytes of space - that is a separate topic on which I will try to post in the future!
Best Wishes
Som
1. Firstly, always leave the recorder running, as interesting things happen suddenly, and turning on the recorder after that mises the key event! These days with large capacity hard disk recorders, I leave it running through the whole operating list - and if nothing of interest occurred, then one can simply wipe the track andrerecord over it the next day!
2. Camera- currently the Sony 3 chip (EXWAVE HAD) cameras still seem to be the best. There are a few new HD cameras out, which are both very expensive, and till most venues get facilities to project HD, maynot be worth the investment
3. Link, Firewire from camera direct to recording device is best - the feed should go straight to the recorder & output from recorder to your TV monitor (not the other way round), A Composite video link, probably delivers similar quality (if your camera doesn't have firewire output)
4. Recorder - I am currently using a hard disk recorder from Datavision. This has 250GB removable drives, so you can record a few days surgery on on disk, take it out - take it to your office/home where you can copy files to PC/Mac and select the bits you want to keep. The rest are deleted. If you have a couple of spare disks, then you can be recording on the next one, whilst sorting the content of the first - so a sort of cycle goes on. Beware of recording direct to DVD, as this is already compressed to mpeg, and whilst output looks good, once you have edited (and sometimes redited more than once), there is loss of quality - the editing software basically tries to decompress the footage, and once you have edited it, recompress it, so every editing cycle has a depreciating effect on quality. Also some hard disk recorders actually compress to mpeg as they record (The Sony medical grade hard disk recorder records as mpeg), what you want is a recorder which records as a native DV stream (Datavision does that) or a relatively lossless format such as AVI - great for mac users as they are already set up to handle DV, but PC users (like me!) can still access the quality if they have the correct software - I use Adobe Premiere CS4, which allows me to import DV files directly and renders them well after editing, although if I play these DV files directly (say through Windows Media Player), the quality is rubish! But once imported into Adobe Premiere - quality is great! Codecs are a dark art which I do not fully understand - but I am here merely trying to explain what works for me (and maybe will for you).
5. Software - If you have an academic connection (Hony Lecturer, whatever), or even a child in full time education, you maybe able to get software on educational prices, which are much cheaper than market rates. I am told (unconfirmed) that Apple UK, if you ring them and say you are a NHS doc who teaches medical students, will give you a discount upto 15% - I haven't tried this being a pC use, but for some of you that may be worth trying.
6. Archiving - this is the biggest problem - Video files are huge - an if You have yaers of them, then you need terabytes of space - that is a separate topic on which I will try to post in the future!
Best Wishes
Som
Monday 27 April 2009
Central detachment with myopic hole in extreme myopia
Gentlemen (& ladies),
I did an extreme myope -18 D, phakic with a posterior central detachment and a macular hole. Careful peripheral indented search showed no other holes. I thought I had induced a PVD, but on injecting dilute Triamcinolone realised that there was a very thin sheet of adherent vitreous still there, this was very resistant to come off, and had to be scraped off with a Tano Diamond dusted scraper. Yasou Tano has shown these cases in the past at various meetings, so I had an idea of what needed doing. Having cleared the vitreous and adherent hyaloid to the equator (at least), I decided to do a mid periphereal retinotomy to flatten the retina and then used brilliant peel (blue)under air hoping to stain ILM and remove it. PFCL fill after retina is flat under air, but when I put contact lens on to try and focus on ILM, I just could not get it to focus! Tried to peel ILM through BIOM view - I think with partial success. Laser to retinotomy and an area of 'suspicious' retina peripherally, then direct PFCL to silicon oil exchange. Let us see how she does.
I will try to make the time to edit the video and post it on my blog over the next few days - so watch this space
Som
I did an extreme myope -18 D, phakic with a posterior central detachment and a macular hole. Careful peripheral indented search showed no other holes. I thought I had induced a PVD, but on injecting dilute Triamcinolone realised that there was a very thin sheet of adherent vitreous still there, this was very resistant to come off, and had to be scraped off with a Tano Diamond dusted scraper. Yasou Tano has shown these cases in the past at various meetings, so I had an idea of what needed doing. Having cleared the vitreous and adherent hyaloid to the equator (at least), I decided to do a mid periphereal retinotomy to flatten the retina and then used brilliant peel (blue)under air hoping to stain ILM and remove it. PFCL fill after retina is flat under air, but when I put contact lens on to try and focus on ILM, I just could not get it to focus! Tried to peel ILM through BIOM view - I think with partial success. Laser to retinotomy and an area of 'suspicious' retina peripherally, then direct PFCL to silicon oil exchange. Let us see how she does.
I will try to make the time to edit the video and post it on my blog over the next few days - so watch this space
Som
Sunday 29 March 2009
Odd submacular lesion with fibrosis
This right eye was initially treated with a haemorrhagic PED in early 2007, presenting with a vision of 6/24. Three Avastin injections were given at 6 weekly intervals, and things settled nicely with vision varying between 6/18 and 6/12 on subsequent visits. The last injection was September 2007.
Things remained stable till Feb 09, when she came back with a new complain of seeing a 'blob' in her central vision in her right eye.
Vision was still 6/18
Ant Seg - unremarkable, no cells in her vitreous.
Ant Seg - unremarkable, no cells in her vitreous.
This is her colour fundus photo:
Red Free pictures
She has a clear history of Flourescien allergy, so we couldn't do one.
IR photo:
Her early ICG is shown
Late ICG
Early ICG movie
Mid-phase ICG movie
Late ICG movie
Other eye had PDT some years ago for a fibrovascular PED and settled to a vision of 6/36, been stable for 5+ years.
Any idea about diagnosis? Management?
Wednesday 25 March 2009
Another 25g Retinal detachment video
Another video showing proper technique to overcome 'weaknesses' of 25g technology.
A good chandelier light and extensive use of deep indentation, means that surgical goals can be achieved, even with relatively flexible instruments.
A good chandelier light and extensive use of deep indentation, means that surgical goals can be achieved, even with relatively flexible instruments.
10th Antwerp VR course 2009
Just got back from Antwerp, excellent meeting as usual in it's 10th edition.
Big play on air tamponade only for macular hole with 3 day face down posturing. I've done a few caes like this with mixed results, anyone else tried this?
The gauge wars continue - 25, 23 or 20? Different people propunding the virtues of one system over the other. What is the outside diameter of a 20g Trocar cannula system for transconjunctival surgery? Must be 19 gauge, if 20g instruments go through the cannula? Will have to look this one up.....
Som
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