Anterior Vitreous Face Behavior

Hugo Scarfone, MD; Jose Jeronimo Riera, MD; Maria Carolina Rodriguez, MD; and Sergio Epelbaum, MD

Eyetube

Navigating Vitreous Loss in Cataract Surgery

An experienced retina surgeon shares his tips.

Steve Charles, MD, FACS, FICS

Cataract and Refractive Surgery Today

The intersection of anterior and posterior segment techniques presents unique challenges and learning opportunities for cataract surgeons. This article offers an in-depth exploration into the management of vitreous loss—a situation that every cataract surgeon may encounter. INFUSION SITE A sideport limbal incision is the optimal infusion site for performing an anterior vitrectomy for vitreous loss during cataract surgery. Infusion is required—dry vitrectomy lowers IOP, potentially leading to a catastrophic suprachoroidal hemorrhage. The vitrectomy probe can be inserted through a second sideport incision or preferably the pars plana. NUMBER OF VITRECTOMY PORTS A single-port vitrectomy is a bad idea. O’Malley and Heintz developed the three-port vitrectomy system.1 Separating infusion from the vitrectomy probe reduced turbulence, boosted the efficiency of vitreous removal, and increased flexibility. ORIENTATION OF THE INFUSION CANNULA An elective three-port vitrectomy requires a pars plana infusion cannula, typically placed 3.5 mm posterior to the limbus. The top of the hub of the infusion cannula should align with the horizontal meridian. Placing the cannula in the inferotemporal quadrant poses the risks of a partial pull-out and inadvertent, dangerous suprachoroidal infusion when the eye is rotated inferiorly.

Practice Makes Progress

Marion Munk, MD, and Justis P. Ehlers, MD

Retina Today

It’s always fascinating when trendy technology seeps into health care. While working on this issue, our news feeds were overrun with stories of surgeons using Apple’s new Vision Pro in the OR.1 According to the press release, a nurse used the device to help with instrument selection, data visualization, and procedure monitoring.1 Cool stuff, and even if you aren’t an Apple aficionado, you have to admit this “spatial computer” is impressive.2 The news caught our eyes, but it didn’t surprise us because the field of retina was way ahead of the curve with this technology. The first ophthalmic exoscope—the Beyeonics One visualization system—that integrates augmented reality into a surgical headset was installed into an ophthalmic surgical suite years ago.3 Not only that, but the company recently announced the integration of intraoperative OCT into the headset, making it something of a spatial computer itself—for the surgeon.4 Retina has always been a field defined by technologic advancement, and our imaging tools are a great example. In an explosion of innovation in the early 2000s, we saw the advent of 3D visualization in the OR, intraoperative OCT, and OCT angiography (OCTA). Since then, it has been a slow march of improvement. For example, the January/February issue highlighted the addition of fluorescein angiography to surgical 3D heads-up displays. Other issues have touched on scanning laser ophthalmoscope-based multimodal fundus imaging and ultra-widefield technologies for the detection of diabetic eye disease. To catch up on these articles, see Further Reading. Some technology still in the pipeline may be poised to hit the clinic in the next few years; K. Bailey Freund, MD, and others have been lecturing on high-resolution OCT for a while now, with Retina Today following closely since its inaugural issue in 2006.5 While researchers work on fine-tuning the next generation, we asked experts to share their insights to help you perfect your skills with the imaging tools at your disposal.