VBS 2023: Surgical Papers

Jonathan Tijerina
Bascom Palmer Eye Institute
Miami, FL

Session 8 of the Surgical Scientific Papers titled “I See This Spark in You. It’s Amazing. It’s Why I Push You. But It’s Yours” of the 11th Annual Vit-Buckle Society Meeting moderated by Drs. Tarek Hassan and Dimitra Skondra highlighted recent developments in the areas of multimodal imaging-guided surgical interventions, comprehensive analysis of retinal detachment outcome predictors, and the advantages of using a contact lens-based interface for retinal surgery.

The session began with Dr. Sean Adrean from the Retina Consultants of Orange County group presenting his work titled “Purposeful Pneumatic Induced Resorption of Submacular Fluid in Macula-off Retinal Detachments (Persimmon Study).” During this session, Dr. Adrean shared a retrospective analysis of patients with macula-off retinal detachments who were intentionally left with some residual submacular fluid after vitrectomy or vitrectomy and scleral buckle with SF6 or C3F8 gas fill. Mean best corrected visual acuity was achieved at 14 months for most patients. Notably, time to repair of detachment varied from less than one day to greater than three weeks and visual acuity increased comparably in all groups. This suggests that surgeons may attain good visual outcomes even with a longer duration of submacular fluid.

Dr. Jonathan Chang from the University of Wisconsin-Madison presented his work titled “Combining Volk Widefield Contact Lens with Resight Retina Surgery System.” In this presentation, Dr. Chang describes the advantages of the custom 3D-printed adapter which enables the use of the Volk Miniquad XL lens with the Ziess Resight for intraoperative contact lens-based fundus visualization. Advantages include less dependence on assistants, improved peripheral views, lack of condensation, reduced corneal aberration, and less risk of inadvertently contacting the cornea. Challenges include canula placement, positioning with prominent brows, and adjustments to scleral depression in some scenarios.

Dr. Gerardo Garcia-Aguirre from the Asociación para Evitar la Ceguera en Mexico (Association for the Prevention of Blindness in Mexico) presented his work titled “There’s  a Fish in My Vitreous!!! Visualizing Vitreous Opacities Using Dynamic Ultra-Widefield Infrared SLO.” In this retrospective series he characterized the use of dynamic ultra-widefield infrared confocal scanning laser ophthalmoscopy (IRcSLO) in classifying patients with vitreous floaters according to a severity scale previously proposed by Dr. Garcia-Aguirre’s team. The most common cause of symptomatic vitreous floaters was PVD, followed by vitreous syneresis, asteroid hyalosis, and vitreous hemorrhage. Higher severity score was associated with increasing age and identifiable Weiss Ring. These results further the work of Dr. Garcia-Aguire and his group, demonstrating the utility of dynamic ultra-widefield IRcSLO imaging for categorizing vitreous floaters and, hopefully in the future, aiding surgeons in making objective decisions to intervene or observe these patients.

Dr. Sally Ong from the the Wake Forest School of Medicine presented her research titled “Predictors of Poor Visual Outcome After Repair of Uncomplicated Rhegmatogenous Retinal Detachments.” In this study, Dr. Ong’s team demonstrated that PPV has become the preferred surgical approach to repair uncomplicated RRD’s over the last 10 years compared with SB, PPV/SB, and PR, and appears to be preferred especially by younger surgeons. However, as the rate of long-term single surgery anatomic success (SSAS) was superior in SB and PPV/SB compared to PPV, and one-year BCVA was only significantly improved in eyes that achieved SSAS, SB and PPV/SB should be more frequently considered for repair of uncomplicated RRD’s. Dr. Ong’s team also notably found that area deprivation index (ADI) scores are an independent risk factor for BCVA at 1 year, despite no difference in rates of SSAS in the same groups.