PIE magazine’s Daily Congress News on the Posterior Segment
Surgical Retina Techniques and Maneuvers for Better Outcomes by Tan Sher Lynn
Various novel surgical techniques and maneuvers were discussed in a live stream during the American Society of Retina Specialists 38th Annual Scientific Meeting (ASRS 2020) on July 24, 2020. Here are some of the highlights…
Sutureless intrascleral fixation The two-part Surgical Techniques and Maneuvers Symposium started with Dr. Ashkan Abbey from the Texas Retina Associates (USA) , who presented the clinical outcomes of 488 eyes which received sutureless intrascleral (SIS) fixation of intraocular lenses (IOL) as well as the comparative effectiveness of haptic flanging in the series. “Postoperative IOL dislocation in eyes undergoing SIS fixation is most likely to occur after repositioning of a previously dislocated IOL,” he shared. The risk of postoperative IOL dislocation, emphasized Dr. Abbey, may
be reduced by having a low threshold for exchanging a warped or damaged 3-piece IOL. “Flanging of the haptic tips significantly reduces the risk of IOL dislocation. Intraoperative peripheral iridotomies significantly reduce the risk of postoperative reverse pupillary block,” he added.
Using microsurgical vacuum pick Then, Dr. Carl Awh from Tennessee Retina (USA) described the use of the microsurgical vacuum pick (MVP) for membrane peeling without forceps during vitreoretinal surgery. The MVP is a new device that can perform all membrane peeling steps, including creating a membrane edge, securing the membrane, and peeling the membrane from the retina. The most novel feature of the MVP is the micropicks, which is used to create an edge or flap in the ILM or ERM, with minimal risk of damage to the underlying retina.
“The MVP seems more stable and less fatiguing – there’s no need to activate the forceps. It reduces or eliminates instrument exchange. The teasing action used to peel membranes may transmit less stress to macula than peeling with forceps. However, there are occasions when I still prefer the forceps, such as in cases of extremely thick or rigid membranes,” said Dr. Awh.
Dealing with large macular holes Despite a high success rate for macular hole repair (>90%), there are challenging cases that involves large holes (>400 microns), chronic holes (>6 months), macular holes in high myopia and recurrent holes. Dr. Jessica Lee from New York Eye and Ear Infirmary of Mount Sinai (USA) talked about the use of human amniotic graft in the repair of persistent large MH. The study involves 10 patients who had persistently open large macular holes from 3/2019 to 5/2020. All patients underwent pars
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