EURETINA 2025: Kreissig Award Lecture Throwing away wisdom: How we abandon what works

María Berrocal, from Drs. Berrocal and Associates in San Juan, Puerto Rico, delivered the Ingrid Kreissig Award Lecture titled "Throwing away wisdom: How we abandon what works." Her presentation focused on two medical techniques that she believes have been wrongly replaced by newer, less effective methods.

The first technique is the minimal, non-drainage scleral buckle procedure for retinal detachments. Berrocal highlighted that this procedure achieves up to 97% success rates in a single operation, with better visual acuity results and fewer complications compared to primary vitrectomy. She emphasized that this approach is not only more effective but also has a smaller carbon footprint and requires less equipment.

The second technique is pan-retinal photocoagulation for proliferative diabetic retinopathy. Berrocal argued that this 40-year-old method provides long-term stability and excellent visual acuity results, unlike monthly anti-VEGF injections which offer only temporary treatment. She expressed concern about patients who become lost to follow-up with injection-based treatments, potentially leading to severe complications like neovascular glaucoma.

Drawing from her 30 years of experience, Berrocal shared a personal patient case that illustrated the benefits of minimal procedures. She observed that complex vitrectomy procedures can significantly disrupt patients' lives, causing extended recovery times and additional complications like cataracts. Her key recommendations were twofold:

1. For rheumatogenous retinal detachments with few breaks, use a minimal scleral buckle procedure without drainage
2. Maintain pan-retinal photocoagulation as the standard treatment for proliferative diabetic retinopathy

Berrocal's lecture challenged the medical community to critically evaluate new treatments, emphasizing that newer doesn't always mean better. She urged physicians to prioritize patient outcomes, long-term stability, and quality of life when selecting medical procedures. The lecture concluded by advocating for procedures that provide the best patient results while minimizing complications and follow-up requirements.