VBS 2022 – VR Surgery

Sushant Wagley, MD
VitreoRetinal Surgery, PLLC
Minneapolis, Minnesota

Drs. Dean Elliott and Ella Leung moderated Session 9: “Speak-Easy and Carry a Big Stick” which featured interesting talks highlighted below, which were selected from abstract submissions:

Dr. Murtaza Adam presented his experience with surgical cases performed without intravenous sedation. With the catchy title “IV free is the way to be,” he discussed the pros and cons of performing retinal surgery under oral sedation. Some benefits of this method include minimized post anesthesia sedation/nausea and not needing the patient to be NPO – making it ideal for add-on RD cases or diabetic patients. However, he stressed the importance of careful patient selection, “talkesthesia” and delivery of an adequate sub-Tenon block when pursuing this method.

Dr. Gregory Lee’s talk discussed the use of the soft tip extrusion cannula to reflux balanced salt solution into the sub retinal space for repair of refractory and large macular holes. Instead of using a 39- or 41- gauge needle and VFC oil extrusion cannula to create a sub-retinal bleb, Dr. Lee’s method uses the soft tip cannula on proportional reflux right through intact retina. The injection speed is linearly controlled by the foot pedal to diffuse BSS into the sub retinal space. This step is performed after completing an internal limiting membrane peel. In his experience, Dr. Lee found that the technique is an effective and lower cost alternative to achieve macular separation to relax the adhesions.

Dr. Rajeev Muni presented data on timing of surgical repair for fovea-off and fovea-on retinal detachments using the IRIS database. His analysis showed evidence for improved visual outcome in the group of patients that received earlier repair in both fovea-on and fovea-off patients. He concluded that fovea-off detachments repaired within three days and fovea-on detachments repaired within a day had better outcomes. Finally, he demonstrated patients an example of the slow course of photoreceptor recovery over the span of many years after surgery.

Dr. Sally Ong presented data comparing outcomes of retinal detachments with giant retinal tears repaired via pars plana vitrectomy versus combined scleral buckle and pars plana vitrectomy in an international multicenter retrospective study. Their analysis showed that in patients less than 18 years, single surgery anatomical success was significantly higher with combined PPV+SB procedure when compared to PPV alone. There was no such difference in outcomes when comparing the two approaches in adults.

Dr. Tony Stefater’s talk discussed the use of a novel tamponade agent in repairing rhegmatogenous retinal detachments. He presented results on some of the first human patients that underwent detachment repair with this novel polymer tamponade which was applied on the retinal tears. These initial findings showed that this novel agent can potentially aid in RD repair without requiring gas or silicone oil for tamponade or the need for post-operative positioning.