VBS VI: Endophthalmitis Session

Natalia Fijalkowski Callaway, MD, MS Ophthalmology Resident Bascom Palmer Eye Institute IMG_4436 High noon at VBS: the Retina Calienta fighters entered the ring to heat up the room. Round 1, Maria Berrocal, MD presented a series of videos teaching us to bob-and-weave through the challenging cases of lens repositioning. First, she demonstrated the replacement of a dislocated 3-piece IOL back into the sulcus in a case with good sulcus and capsular support. Then, she showed her use of the flex loop to grasp the haptic of a one-piece IOL. When tackling the challenge of a PMMA one-piece lens when there is no capsular support she recommends an iris fixation technique. She pointed out that each of these cases are different and present their own challenges. Her knockout technique was one previously presented by Dr. Yonekawa accomplishing scleral fixation of a 3-piece lens via 27-G ports with low-temp cautery to secure the externalized haptic. IMG_4438 Round 2, Lihteh Wu, MD jumped into the ring and presented a challenging case of a secondary macular hole and inflammatory changes. With observation alone the patient’s macular changes stabilized and resulted in good ultimate visual acuity. Sometimes less is more… IMG_4440 Round 3, Gabriela Lopez-Carasa, MD took an upper cut at retrobulbar blocks. She pointed out that although the retrobulbar block typically proceeds without consequence, when there is a complication it can be devastating: retrobulbar hematoma, globe perforation, laceration, etc. A surgical video demonstrated her preferred technique for Sub-Tenon's block and she presented a study in Ophthalmology that reports a 60% reduction of serious complications. IMG_4441 Round 4, Gerardo Garcia-Aguirre, MD entered the ring with a case where he is on the ropes - nail penetrating the eye, but through the pars plana, and without a posterior strike site. He asked the audience how they would to manage: conservative removal of nail alone or an aggressive removal/PPV/PPL? In this case, the conservative approach with removal of the nail with scleral closure resulted in a fantastic outcome and vitrectomy was not necessary. Once again, less was more. IMG_4442 Round 5, Dr. Maria Ana Martinez-Castellanos entered the ring to discuss imaging of pediatric vitreoretinal disorders. Angiogram: Pros: Can see choroidal changes, stages, and vasculature Cons: Use contrast, mandatory shot of fluorescein via IV Optos: Pros: Great visualization of a wide-field of retina that offers good documentation, magnification, and can assist in surgical planning. She discussed how infrared can sometimes obviate the need for an FA because the new vessels are visible on high magnification. Cons: The child must be stable for outpatient care and this is often not the case in the premature newborns. IMG_4443 In the final round, Hugo Quiroz-Mercado, MD presented a case of firework trauma resulting in a large corneal laceration with anterior capsular rupture that developed endophthalmitis. The group recommended early culture and intravitreal antibiotics. In the case, vitrectomy with induction of the PVD and peripheral shaving by another surgeon resulted in retinal tears. He offered the lesson that only core vitrectomy is needed in these cases as lifting the hyaloid of a child may result in iatrogenic breaks. IMG_4447 Virgilio Morales-Canton, MD was the referee and moderator for this exciting surgical session at VBS VI. RETINA Roundup VBS VI Coverage: 3/27/2018  VBS VI: Historic Delivery of Gene Therapy for LCA 3/27/2018  VBS VI: Surgical Adventures - Curing One Eye at a Time 3/26/2018  VBS VI: Retinaws 3/26/2018  VBS VI: Complications Session 3/26/2018  VBS VI: Women of VBS Breakfast 3/26/2018  VBS VI: Endophthalmitis Session 3/25/2018  VBS VI: Retina Caliente 3/25/2018  VBS VI: Lifetime Mentorship Award: Jay Duker 3/24/2018  VBS VI: Surgical Adventures - Bridging the Gap 3/24/2018  VBS VI: Real World Retina - Practice Management, Private Equity, Advice for Young Retina Specialists 3/24/2018  VBS VI: Medical Retina 3/24/2018  VBS VI: Live Surgery Session 3/23/2018  VBS VI: Fellows' Forray 3/24/2018  VBS VI: Welcome to Miami