Retinal Surgery

Ophthalmologists share their outlook for the current state and future of the ophthalmic profession, how coronavirus pandemic has altered the profession as well as how —now, more than ever — patient care remains a number one priority for ophthalmologists.

Retina specialists Caesar Luo, MD, of Bay Area Retina Associates, and S.K. Steven Houston III, MD, of Florida Retina Institute, share their outlooks on retina innovation in the "year of the eye" amid a global pandemic.

The number of patients with retinal diseases is steadily increasing in the United States, according to a retrospective study presented during ARVO 2020.

Dilraj Grewal, MD, speaks on his presentation "Evaluating the True 3-Year Recurrence Rate in Non-infectious Posterior Segment Uveitis Following an Injectable Fluocinolone Acetonide Insert," during ASRS 2020.

Daniel F. Kiernan, MD, FACS, speaks on the key findings and take-aways of his presentation "Dexamethasone intracameral drug-delivery suspension for inflammation associated with vitreoretinal surgery."

S.K. Steven Houston III, MD, discusses retina innovations in use in his practice, including the NGENUITY 1.4 upgrade from Alcon, and adapting to ever-changing operating room spacing and set-up in the COVID-19 environment

Treatment with a single ocriplasmin injection led to clinically meaningful improvements in the patient-reported visual function measured by the VFQ-25 questionnaire over 24 months in patients with symptomatic vitreomacular adhesion.

Only 2% of patients with internal limiting membrane peeling developed an epiretinal membrane compared with 46% with no peeling.

Immediate administration after radiation therapy is key.

Use of anxiety-screening questionnaires in patients needing intravitreal anti-VEGF injections may help to identify individuals at risk for elevated pain during the procedure, according to research presented at ARVO 2020.

Face-down positioning is associated with a reduction in certain complications following macula-involving retinal displacement (RD) repair, according to researchers.

Combination therapy benefits from laser in the mix for DME, other conditions

Most commercially available OCT and OCTA devices can provide widefield OCTA through a combination of faster speeds, tracking, and the ability to montage images. This may revolutionize clinicians’ ability to assess and quantify retinal vascular disease.

Lamellar holes usually don’t require treatment, but it is important to recognize the eyes that may benefit from vitrectomy.

Using ultrasonic power to actuate a vitrectomy probe (hypersonic vitrectomy) allows for a “smooth steady flow of vitreous into a port that is oscillating at 1.7 million cycles per minute,” according to Carl C. Awh, MD.

A retinectomy performed under air using a sequenced approach can improve outcomes.

The metastatic prognosis does not increase when vitrectomy is performed at the time of brachytherapy.

Take-Home Message: The Telescopic Intra-Ocular Lens for Visually Impaired People Revolution system is promising to improve the vision in patients with maculopathies.

Take-Home Message: YAG laser vitreolysis might be a treatment option for patients with complaints of floaters. Larger studies of longer duration are needed to corroborate these results.

Modern 27-gauge equipment for vitrectomy has introduced a new paradigm in vitreoretinal surgery marked by enhanced precision and control.

Temporary scleral buckling performed with a removable external device provides the benefits of scleral buckling while addressing its downsides as surgery for a detached retina.

Macular hole surgery can be performed using various techniques and technologies. According to John T. Thompson, MD, the available evidence supports always incorporating internal limiting membrane (ILM) peeling, staining of the ILM, and having a large gas bubble in the eye on the first postoperative day.

Suprachorodial hemorrhage can be managed effectively with a conservative approach, but if surgical intervention becomes necessary, timing is critical for optimizing the outcome and minimally invasive techniques can be considered, said John W. Kitchens, MD.

Removing a small area of internal limiting membrane at the intended site of a subretinal injection allows the injection to be delivered without penetrating the retina.

Looking back at 2016, incremental improvements in devices are changing how retina surgeons approach and treat surgeries, said a group of experts. For Charles Wykoff, MD, PhD, two novel improvements may not radically alter surgical approaches today, but will have a long-lasting impact down the road.

Experience with en face OCT shows its value for following disease progression in wet and dry age-related macular degeneration and in diseases that disrupt the inner segment/outer segment/ellipsoid zone.

Retina surgeons considered 2015 to be an exciting time in the subspecialty in all areas and pointed to the availability and increased use of 27-gauge instrumentation as one of the real highlights of surgical retina.