VBS 2022 – Fellows Foray

Matthew Starr, MD
Assistant Professor of Ophthalmology
Mayo Clinic

As with all recent meetings, it feels good to be back in person. It has been 3 years since the last in-person Vit Buckle Society meeting, and the camaraderie of the crowd was palpable. As with any case conference, presenting in front of a live audience offers the ability for the crowd to interact with the speakers in much more engaging manner than the virtual platform. This year’s annual VBS meeting kicked off with the Fellow’s Foray, with the top 8 surgical videos from fellows all over the world.

The first case was from Dr. Riyaz Bhikoo from the University of British Columbia who presented a remarkable case of intraocular gnathostomiasis, a rare parasitic nematode infection after consumption of raw fish. A truly fascinating video of Dr. Bhikoo grabbing the worm with forceps while it continued to wiggle within the eye. The patient had a great outcome following systemic therapy and removal of the worm from the vitreous cavity. Following Dr. Bhikoo was Dr. Daniel Brill of Cincinnati Eye Institute who presented a blast from the past, with a case submacular surgery. A surgical technique that is not often encountered in this day and age. In the video, Dr. Brill removed a subfoveal CNV membrane, starting with the induction of a large retinal detachment, folding the retina over and holding it in place with PFO while removing the neovascular membrane with forceps. The patient did well with improvement in vision from count fingers to 20/300. This case was hotly debated amongst the panelists as it is something not often done any longer.

Dr. Diana Laura of Bascom Palmer presented a case of every retina surgeon’s worst enemy, MIRAgel. Dr. Laura’s case was truly amazing as the MIRAgel not only was extruding from the eye, but intruding into the vitreous cavity, necessitating both a pars plana vitrectomy and external removal. The panel offered numerous tips and tricks in handling these cases, but Dr. Srivastava’s best advice was to pray to the MIRAgel gods. Dr. Laura had a great surgical outcome, not only saving the eye, but reattaching the retina with improvement in vision. Continuing the theme of nightmare retinal detachments, Dr. Wei Wei Lee from the University of Toronto presented a case of a 14 year-old child who presented with a combined CRAO/CRVO in the setting of systemic hypercoagulability. The patient then went on to develop a full thickness macular hole and subtotal RRD due to the massive edema (although the panelists believe there possible was some sort of vitreoretinopathy in play as well). Dr. Lee beautifully repaired the retina and placed an amniotic membrane into the hole and achieved hole closure with retinal reattachment with improvement in vision under oil.

Dr. Danny Mammo from Cole Eye then presented an unusual IOL dislocation. The patient had previous trauma with iris loss and the previous repair which included an artificial iris. Interestingly, the secondary lens was fixated to the artificial iris, thus this patient had an IOL and artificial iris dislocation. Dr. Mammo elegantly used the modified Yamane technique to rescue the lens and preserve both the lens and artificial iris. Dr. Nita Valikodath from Duke Eye then presented a great case of delayed IOFB that was not picked up on the initial CT scan from the outside hospital. Dr. Valikodath smoothly removed the thin metal wire from a posterior impact site while also peeling away an ERM. The patient had a significant improvement in visual acuity to 20/25.

Dr. Marcelo Ventura Filho of the Altino Ventura Foundation in Brazil then presented a spectacular case of intraocular tattoo dye following a botched conjunctival tattooing by the patients friend. Dr. Ventura Filho was literally operating in the dark, safely and slowly removing the opaque black dye which was inhibiting his view of the retina. Eventually he was able to clear the dye away and complete the full vitrectomy and laser around an area of subretinal dye. The dye actually facilitated the PVD induction, but also led to a pigmentary glaucoma as well as intense post-operative inflammatory reaction. Ultimately, the patient did well with significant improvement in vision. The last case of the evening was from Dr. Sushant Wagley from VitreoRetinal Surgery in Minneapolis who presented a scary case of a vanishing IOFB. During the removal, the IOFB was temporally lost as it was jettisoned out of the eye. Luckily, everyone in the OR was wearing eye protection.

At the end of the night, Dr. Ventura Filho’s intraocular tattoo ink was voted the winning video and he was awarded the coveted buckle from this year’s Fellows Foray.