The greatest innovations in retinal surgery have been technological. One example is the trocars developed within the past 20 years that eliminate retinal holes and vitreous incarceration at sclerotomy sites.

The latest advances comprise 3-D surgery, intraoperative optical coherence tomography (OCT), new stains, instrumentation that consists of smaller-gauge, disposable advanced technology, and advanced vitrectomy probes, said Audina Berrocal, MD, a professor of clinical ophthalmology at Bascom Palmer Eye Institute, University of Miami Miller School of Medicine in Miami, Florida.

She said these advances have improved surgical performance.

Invaluable innovations

Intraoperative OCT facilitates operations needed during gene therapy, such as detaching the retina and injecting viral vectors under the retina. “This technology makes me a better surgeon and allows me to make difficult decisions easier in the operating room,” Berrocal said. Berrocal demonstrated removing a cataract from an infant with persistent fetal vasculature (PFV). Beyond removal of the cataract, the technology also visualizes the stalk inserted into the posterior capsule of the lens and facilitates knowledge of the foveal anatomy in the macula of such infants. “Knowing that a functional macula is present allows parental counseling about patching therapy and visual expectations for their child,” Berrocal said. Berrocal demonstrated a 3-D surgery with intraoperative OCT (EVA system, DORC) that provided high visibility of all procedures in a patient with persistent fetal vasculature.

She demonstrated the separation of the stalk from the posterior capsule using a vitrector. The technology also permits the surgeon to look for the foveal center; in this case, the fovea was captured in the stalk. The Finesse Flex Loop (Alcon) is retractable and acts as a scraper to remove the hyaloid membrane. If the hyaloid membrane does not remove easily with the vitrector, one may use the flex loop at the optic nerve or at the fovea. Once the hyaloid membrane has been removed, Berrocal shortens the loop and uses it as a pick. Berrocal said the instrument has a consistent contact profile in contrast to earlier versions. It is open in the middle, so that as one scrapes, one visualizes the retina.

The loop also can be used as a lasso. Berrocal said that in a demonstration, a physician used the loop to capture a cyst through a retinotomy. She said she has used this instrument to remove intraocular foreign bodies and under the retina to remove proliferative vitreoretinopathy bands. A new stain, TissueBlue (DORC), was approved recently by the FDA. This stain is heavy and deposits easily on the macula. The product is packaged premixed in individual syringes, in contrast to indocyanine green (ICG), which has to be mixed in the operating room. The premixed stain eliminates potential toxicity or mistakes associated with the mixing of the stain before use.

The Finesse Sharkskin forceps (Alcon) is a new instrument for peeling of delicate internal limiting membranes that easily grasps tissue because of rough edges at the tips that facilitate easy elevation, Berrocal said.

Media contact:

Williams

Managging Editor

Journal of Clinical and Experimental Ophthalmology

Mail ID: opthalmology@peerjournal.org

WhatsApp no: + 1-504-608-2390