Vitreo-macular traction

I used to find diagnosing a Vitreo-macular traction very difficult before the advent of routine OCT. OCT has really enhanced our understanding of the retinl pathology, and 3D rendering can show the pathology even better.

VMT shown clearly on OCT here:

I offerred this patient surgery rather than laser or intravitreal injections and he did very well.

A 3D rendering of VMT -

Oil in AC

Here is someone who I treated for a GRT, pseudophake with an Acrysof len in, so no anticipated ant seg problems. Having sorted his retina out, proceeded to a direct PFCL to OIl exchange, everything went swimmingly, till right at the end - some oil made it's way through the zonules into the AC. You see a sign, the iris is suddenly not sitting on the IOL , but billowed forward!

Should I have done something more at that stage? Who knows, I decided to close up and posture patient face down - hoping to let the oil go back into the posterior chamber...

Did it work - Heck

5 days later patient has an iris plastered to the corneal endothelium, and running pressures over 50 inspite of maximal medication...


What should one do now?

Discuss your surgical techniques

Gentlemen and Ladies,

A lot of the meetings and journals we attend/read concenterate on 'new' treatments and techniques. Basic training in surgical technique is left to a 'apprenticeship' with one's trainer and osmosis from others together with evolution of technique through experience. I propose to discuss the basic surgical tecniques involved in various cases using video clips in this blog and invite others to do so. The format should be a video clip highlighting some problems/difficulties faced, and then to invite others to comment, or give on own views on how these could have been avaoided / better dealt with.

This should not only give those starting out in VR surgery a rich experience, but also cross- fertilise ideas amongst those of us who are more experienced.

I find that the best way of learning surgery, or improving one's technique is by watching your own surgical video. This is an extension of the same principle, by letting others watch your surgery here, you can benefit from others ideas about how to improve your surgery. If you prefer to stay anonymous - send your short write up and video clip to me and I will post it without any identifiable details

You can upload videos directly to the posts (they are hosted on Google Video). If you have any trouble, you can send the video to me, and I can upload it for you. The most practical way of sending across large video files is to use a service such as YouSendIt (free for files under 100 MB). If you are files are larger than this, use a program such as 'Windows Movie Maker' (free in Windows), to compress it for download.

If you still have queries about how to do this, please feel free to email me.

Let's give it a try and see how it pans out.

Best Wishes

Som