About
Editors & Authors
Luis Acaba-Berrocal
MD
Illinois Eye and Ear Infirmary, University of Illinois Chicago
Chicago, IL, USA
Armin Afshar
MD MBA MAS
University of California , San Francisco
San Francisco, CA, USA
Hasenin Al-khersan
MD
Bascom Palmer Eye Institute
Miami, FL, USA
Thomas Arno Albini
MD
Bascom Palmer Eye Institute; University of Miami Health
Miami, FL, USA
Sulaiman Alhumaid
MBBS FRCSC
Bascom Palmer Eye Institute
Miami, FL, USA
Abhilasha Alone
DNB
LV Prasad Eye Hospital
Hyderabad, India
Rodrigo Anguita
MD
Moorfields Eye Hospital
London, United Kingdom
Chandrakumar Balaratnasingam
MD PhD FRANZCO
Lions Eye Institute; University of Western Australia; Sir Charles Gairdner Hospital
Perth, Australia
Daniel Barthelmes
MD PhD EMBA FEBO FMH Ophthalmology & Ophthalmic Surgery
University Hospital; University of Zurich; Save Sight Institute; The University of Sydney
Zurich, Switzerland and Sydney, Australia
Peter J. Belin
MD
VitreoRetinal Surgery, PLLC
Minneapolis, MN, USA
Audina M. Berrocal
MD
Bascom Palmer Eye Institute; University of Miami; Miller School of Medicine
Miami, FL, USA
Maria H. Berrocal
MD FASRS
CEO Drs. Berrocal & Associates; University of Puerto Rico
San Juan, PR
Gaurav Bhardwaj
BMed PhD FRANZCO
Westmead Hospital; Liverpool Hospital; Sydney Children's Hospital Network
Sydney, Australia
Kapil Bhatia
MBBS, MS
C-Mer Dennis Lam Hospital (Shenzhen, China)
Jaipur, India
Anant Bhosale
MD, FICO, FVRS, MRCS(Edin)
Sir Charles Gairdner Hospital and Lions Eye Institute
Perth, Australia
Kiran A. Billawala
BSc
Retina Consultants of Texas
Houston, TX, USA
Geoffrey Chan
MBBS (Hons), FRANZCO, MMedSc (UWA), PGCert Med Ed (University of Cambridge)
Lions Eye Institute, University of Western Australia
Perth, Australia
Jason Chung Kit Chan
AFCOphth (HK) MRCSEd(Ophth) MB ChB(CUHK) MPhil(CUHK) BSc (CUHK)
Hong Kong Eye Hospital
Hong Kong, China
Andrew Chang
MBBS(Hons) PhD FRANZCO FRACS
Sydney Eye Hospital
Sydney, Australia
Jonathan S. Chang
MD
School of Medicine and Public Health, University of Wisconsin
Madison, WI, USA
Stanley Chang
MD
Columbia University Vagelos College of Physicians and Surgeons
New York, NY, USA
Steve Charles
MD FASRS FACS FICS
Clinical Professor of Ophthalmology, University of Tennessee
Germantown, TN, USA
David Charteris
MBBS FRCOphth
Moorfields Eye Hospital; NHS Foundation Trust
London, UK
Fred Chen
MBBS (Hons) PhD (London) FRANZCO
Centre for Ophthalmology and Visual Science, University of Western Australia
Perth, Australia
Kuan-Jen Chen
MD
Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, College of Medicine, Chang Gung University
Taoyuan, Taiwan
Jay Chhablani
MD
University of Pittsburgh Medical Center
Pittsburgh, PA, USA
Hung-Da Chou
MD
Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, College of Medicine, Chang Gung University
Taoyuan, Taiwan
Netan Choudhry
MD FRCS(C) DABO
Co-Founder & Medical Director Vitreous Retina Macula Specialists of Toronto; Staff Ophthalmologist Cleveland Clinic Canada; University of Toronto Department of Ophthalmology & Visual Sciences
Toronto, Canada
Mina M. Chung (Posthumous)
MD
Flaum Eye Institute, University of Rochester
Rochester, USA
Lyndon Da Cruz
MA MBBS PhD FRCOphth FRACO
Moorfields Eye Hospital
London, UK
Miguel Cruz Pimental
MD
Department of Ophthalmology and Vision Sciences
University of Toronto
Toronto, Canada
Bertil E. Damato
MD PhD FRCOphth
Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford; Ocular Oncology Service, Moorfields Eye Hospital
London, UK
Marc D. de Smet
Bsc MDCM PhD
Oxular
England, UK
Uday Devgan
MD, FACS, FRCS (Glasg)
UCLA / Jules Stein Eye Institute
Los Angeles, CA, USA
Dean Eliott
MD
Massachusetts Eye & Ear, Harvard Medical School
Boston, MA, USA
David Charles Andrew Fabinyi
MBBS(Hons) FRANZCO
The Royal Victorian Eye and Ear Hospital; University Hospital Geelong; Barwon Health
Melbourne, Australia and Geelong, Australia
Jason Fan
MD PhD
Bascom Palmer Eye Institute
Miami, FL, USA
Yale L. Fisher
MD
Bascom Palmer Eye Institute; Weill Cornell Medicine; Vitreous Retinal Macula Consultants of New York
Miami, FL, USA and New York, NY, USA
Blanca C. Flores-Sanchez
MD CHM
Moorfields Eye Hospital; NHS Foundation Trust
London, UK
Harry W. Flynn, Jr
MD Professor of Ophthalmology
The J. Donald M. Gass Distinguished Chair in Ophthalmology; Bascom Palmer Eye Institute; UHealth - University of Miami Health System
Miami, FL, USA
Kenneth Fong
FRCOphth FRANZCO
Managing Director, OasisEye Specialists
Kuala Lumpur, Malaysia
Sunir J. Garg
MD FACS FASRS
Co-Director Retina Research Unit, MidAtlantic Retina; The Retina Service of Wills Eye Hospital, Thomas Jefferson University
Philadelphia, PA, USA
Suzie A. Gasparian
MD
Vitreoretinal Surgery Fellow
Baylor College of Medicine
Houston, TX, USA
Ninel Gregori
MD
Bascom Palmer Eye Institute
University of Miami
Miami, FL, USA
R Rishi Gupta
MD FRCSC
Dalhousie University
Halifax, Nova Scotia, Canada
Rachael C. Heath Jeffery
BAppSc(Hons) MChD MPH
Centre for Ophthalmology and Visual Science (OTEL group), University of Western Australia
Perth, Australia
Michael J. Heiferman
MD
University of Illinois at Chicago
Chicago, Illinois, USA
Christopher R. Henry
MD FASRS
Retina Consultants of Texas
Adjunct A/Prof of Ophthalmology, University of Texas Health Science Center
A/Prof Clinical Opthalmology, Houston Methodist Hospital
Houston, TX, USA
Hong-Uyen Hua
MD
Cleveland Clinic Cole Eye Institute
Cleveland, OH, USA
Rehan M. Hussain
MD
Retina Associates
Chicago, IL, USA
Danilo Iannetta
MD PhD
Ophthalmology Unit, DIMES, Alma Mater Studiorum, University of Bologna and Sant’Orsola- Malpighi Teaching Hospital
Bologna, Italy
Sana Idrees
BA MD
Flaum Eye Institute, University of Rochester
Rochester, NY, USA
Shangjun (Collier) Jiang
BMSc MD
Department of Surgery, University of Calgary
Calgary, Alberta, Canada
Thomas Jenkins
MD
Wills Eye Hospital
Philadelphia, USA
David Karl
MD FRCOphth FEBO
Landesklinikum Mistelbach-Gänserndorf
Mistelbach, Austria
Dvir Koenigstein
MD
Ophthalmology Division, Tel Aviv Sourasky Medical Center, Tel Aviv University
Tel Aviv, Israel
Gregg T Kokame
MD MMM FASRS
Chief of Ophthalmology and Clinical Professor, University of Hawai’i John A Burns School of Medicine
Founding Partner and Senior Consultant, Retina Consultants of Hawai’i
Medical Director, Hawai’i Macula and Retina Institute
Hawai’i, USA
Chi-Chun Lai
MD
Department of Ophthalmology, Chang Gung Memorial Hospital; College of Medicine, Chang Gung University,
Keelung, Taiwan and Taoyuan, Taiwan
Timothy Y. Y. Lai
MD FRCS FRCOphth
Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong; 2010 Retina and Macula Centre, Hong Kong
Kowloon, Hong Kong
Dennis Lam
MBBS MD FRCS FRCO
C-MER Dennis Lam Eye Hospital
Shenzhen, China
Anat Loewenstein
MD, MHA
Director, Ophthalmology Division, Tel-Aviv Medical Center; Associate Dean, Sackler Faculty of Medicine, Tel-Aviv University; President, Israeli Ophthalmological Society
Tel Aviv, Israel
Jiao Lyu
PhD MD
Shanghai Jiaotong University, Medical School, Xinhua Hospital
Shanghai China
David A. L. Maberley
MD MSc (Epid) FRCSC
University of Ottawa
Ottawa, Canada
James C. Major
MD PhD
Clinical Assoc Prof of Ophthalmology, Blanton Eye Institute/Houston Methodist Hospital/Weill Cornell
Retina Consultants of Texas
Houston, TX, USA
Andrew Merkur
MD FRCSC
UBC Department of Ophthalmology
Vancouver, British Columbia
William F. Mieler
MD
Cless Family Professor and Vice-Chairman; Director Vitreoretinal Fellowship Training, Department of Ophthalmology & Visual Sciences, University of Illinois at Chicago
Chicago, IL, USA
Ronald Milam
MD
Cleveland Clinic Cole Eye Institute
Cleveland, OH, USA
Amit Mishra
MD
University of Alberta
Edmonton, AB, Canada
Rajeev H. Muni
MD MSc FRCSC FASRS
St. Michael’s Hospital/Unity Health Toronto, Vice-Chair Clinical Research, Department of Ophthalmology and Vision Sciences, University of Toronto
Toronto, Canada
Marco Mura
MD
Professor and Chairman, Department of Ophthalmology, University of Ferrara, Italy
Retina Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
Roderick O'Day
FRANZCO
Ocular Oncology Service, Moorfields Eye Hospital
London, United Kingdom
Mali Okada
MBBS MMed FRANZCO
Vitreoretinal Unit, Royal Victorian Eye and Ear Hospital; Centre for Eye Research Australia, The University of Melbourne
Melbourne, Australia
Perach Osaadon
MD MBBS
Sydney Eye Hospital
Sydney, Australia
D. Wilkin Parke III
MD
VitreoRetinal Surgery, PA
Minneapolis, MN, United States
Nimesh A. Patel
MD
Instructor of Ophthalmology, Harvard Medical School; Vitreoretinal Surgeon, Massachusetts Eye and Ear Infirmary; Director of Pediatric Retina, Boston Children's Hospital; Voluntary Assistant Professor, Bascom Palmer Eye Institute
Boston, MA, USA
Tapan P. Patel
MD PhD
Johns Hopkins University, Wilmer Eye Institute
Baltimore, MD, USA
Aleksandra Rachitskaya
MD
Cleveland Clinic Cole Eye Institute
Cleveland, OH, USA
Nishant Vijay Radke
MBBS MD FMRF
Senior Consultant and International Faculty, Chief Executive of International Faculties at C-MER Dr. Dennis Lam Eye Hospital
Shenzhen, China
William H. Ross
MD FRCSC
University of British Columbia
Vancouver, Canada
Elizabeth J. Rossin
MD PhD
Massachusetts Eye & Ear, Harvard Medical School
Boston, MA, USA
Paisan Ruamviboonsuk
MD
Clinical Professor of Ophthalmology and Chief of Department, Rangsit University , Rajavithi Hospital
Bangkok, Thailand
Ploysai Rujkorakarn
MD
FICO, Department of Ophthalmology, Rajavithi Hospital
Bangkok, Thailand
Ananth Sastry
BSc MD
Duke University School of Medicine
Durham, NC, USA
Adrienne W. Scott
MD FASRS
Associate Professor of Ophthalmology, Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine
Baltimore, MD, USA
Nathan L. Scott
MD MPP
Bascom Palmer Eye Institute
Miami, FL, USA
Jesse D. Sengillo
MD
Bascom Palmer Eye Institute
Miami, FL, USA
Emily Han Shao
MBBS BSc FRCOphth
Sydney Eye Hospital Eddie Donaldson Vitreoretinal fellow
Surrey, UK
William E. Smiddy
MD
University of Miami Miller School of Medicine, Bascom Palmer Eye Institute
Miami, FL, USA
Parinya Srihatrai
MD
FICO, Department of Ophthalmology, Rajavithi Hospital
Bangkok, Thailand
Wee Min Teh
MD, MMed, CCFT
Consultant Ophthalmologist and Vitreoretinal Surgeon
OasisEye Specialists Seremban
Negeri Sembilan, Malaysia
Daniel S.W. Ting
MBBS BSc FRCOphth M Med (Ophth) FAMS, PhD
Singapore National Eye Centre
Singapore, Singapore
Cynthia Ann Toth
MD
Duke University School of Medicine
Durham, NC, USA
Justin Howard Townsend
MD
Bascom Palmer Eye Institute, University of Miami Health
Miami, FL, USA
Khoi Tran
BPharm MBBS MMed (Ophth) FRANZCO
University of Sydney, University of British Columbia
Gold Coast, Australia
Andrew S.H. Tsai
MBBS MMed(Ophth) FRCOphth FAMS MCI
Fellow in Surgical Retina, Singapore National Eye Centre
Singapore
Luis E. Vazquez
MD PhD
Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
Miami, FL, USA
John D. Wilgucki
MD
University of Illinois at Chicago
Chicago, IL, USA
Edmund Y. M. Wong
MBBS MMed FRCS FAMS
Singapore National Eye Centre
Singapore, Singapore
Wei-Chi Wu
MD PhD
Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center; College of Medicine, Chang Gung University
Taoyuan, Taiwan
Peng Yan
MD FRCSC
Kensington Eye Institute; Department of Ophthalmology and Vision Sciences
University of Toronto
Toronto, Canada.
Nicolas Yannuzzi
MD
Assistant Professor Clinical Ophthalmology, Department of Vitreoretinal Surgery and Diseases; Bascom Palmer Eye Institute, University of Miami School of Medicine
Miami, FL, USA
Peiquan Zhao
MD
Department of Ophthalmology, Xinhua Hospital, affiliated to Shanghai Jiaotong University School of Medicine
Shanghai, China
To the three favourite girls in my life: Cynthia, Aria and Elodie.
Although the first modern vitrectomy was performed over 50 years ago, between the prevalence of scleral buckling and the lack of modern camera capabilities, most retinal surgery had been relegated to the visual vacuum of a darkened operating room suite - ennui for all but the surgeon and assistant - until the last decade or so. Sharing information challenged the imagination and was necessarily limited. Once suitable cameras and editing options were developed, finally surgical techniques and experiences could be revealed in a more vivid and meaningful fashion. Dr. Fung pioneered that media with his first edition of the Vitreoretinal Surgery Online work. I am privileged to introduce the second edition which presents the virtual explosion of new techniques and expanded, newer indications for vitreoretinal surgery, assembled with the necessary assistance of multiple new senior editors.
This editorial team has assembled a magnificent and comprehensive collection of videos with step by step written explanations and key illustrations for the full spectrum of vitreoretinal surgical procedures. One of the hallmarks of current vitreoretinal surgery is that there are now often multiple ways to achieve the same objectives – bordering on too many it seems at times - with a dizzying array of options not without some differing opinions as to their relative merits. This expanded, second edition gives fair and balanced attention to provide the reader with the full gamut of these options from some 93 contributors from the world over. The strategic screen shots which accompany the explanation of the videos is a format that enhances the readers’ grasp of techniques that they may have never tried or seen, lending a cornucopia of pearls and tips to maximize effective surgical results.
This is a must-see resource for the trainee and the experienced vitreoretinal surgeon alike, and the digital format makes it available at our fingertips throughout the entire world! Kudos for making a great work better!
William E. Smiddy, MD
M Brenn Green Professor of Ophthalmology
University of Miami Miller School of Medicine
Bascom Palmer Eye Insititute
Miami, FL
It has been ten years since the First Edition of “Vitreoretinal Surgery for Trainees” was published. That textbook was a collation of my first-hand experience in vitreoretinal surgery, written in practical language that provided step-by-step instructions for Ophthalmology Fellows learning the art of this science. This Second Edition has two major advances. Firstly, it has been made available open-source and online, so that it is available to any surgeon, anywhere in the world. We hope that that it will be referenced frequently in the operating room. The online format also allows for future updates of this living resource, and comments are always welcome using the link on the homepage. Secondly, this has been an international collaboration with 91 authors worldwide, including surgeons who are respected leaders in their field and their Fellows. Over 20 new chapters have been added, with new Figures and the addition of surgical videos. We hope that you will learn as much from this textbook as we have enjoyed writing it and continue to advance the knowledge of this wonderful subspecialty.
Professor Adrian T Fung on behalf of the Editorial Team
Nicholas Yannuzzi
Sebastian Waldstein
Nimesh Patel
Kenneth Lee
Raymond Guan
DEDICATION
To Andrew, Bill, David, Dave and Patrick,
for your time, patience, guidance, generosity and friendship, and for teaching me the secrets of vitreo-retinal surgery
FOREWORD
Dr. Adrian Fung has written an exceptional textbook covering all facets of vitreo-retinal surgery. The text is specifically designed for vitreo-retinal surgeons in training. In the section on retinal detachment, he reviews the surgical options which include pneumatic retinopexy, scleral buckling and vitrectomy surgery with or without a scleral buckle. He discusses the important factors in deciding which procedure is best for the particular patient. The textbook also reviews surgical management of proliferative diabetic retinopathy, epiretinal membrane peel, macular hole repair, vitreoretinal traction syndrome, pars plana lensectomy, intraocular lens removal with secondary lens implantation, penetrating eye injuries, supra-choroidal haemorrhage, endophthalmitis, vitreous biopsies and submacular haemorrhage.
As retinal specialists, every surgical case is unique and presents a puzzle, usually technical or intellectual, that must be considered and solved. There are usually many different approaches to addressing a particular surgical task but ultimately, our training and recent successes define our approach. Surgical retina is an apprentice-based learning endeavour that is not grounded in well-conducted clinical trials or systematic reviews of the literature. The procedures that have been developed to restore sight in the setting of posterior segment pathology are the result of decades of incremental refinements of both technique and instrumentation. This is the basis on which this book has been created.
In this book you will find step-by-step descriptions of all the components of vitreo-retinal surgery. Techniques are presented in a practical and well-organized fashion and numerous helpful “pearls” and “pitfalls” are highlighted throughout. This is an uncommon approach to a surgical book, but one that fellows and surgeons early in their careers will find very useful, especially as a quick review prior to undertaking specific procedures. His excellent photographs are also very useful in understanding the surgical techniques applied.
Dr. Fung is to be congratulated on producing a comprehensive, detailed manual outlining the repair and management of all forms of vitreo-retinal disease.
David A.L. Maberley, MD, MPH, FRCSC
Professor of Ophthalmology Head, Retina Division
Department of Ophthalmology and Visual Sciences University of British Columbia, Vancouver, Canada
William H. Ross, MD, FRCSC
Clinical Professor of Ophthalmology Former Head, Retina Division
Department of Ophthalmology and Visual Sciences University of British Columbia, Vancouver, Canada Chairman Retina Division
Providence Health Care, Vancouver, Canada
FOREWORD
It gives me great pleasure to write this foreward to Dr. Adrian Fung’s new textbook, not only because the author underwent his ophthalmology registrar (residency) training at the Sydney Eye Hospital but because this book makes a significant contribution to the material available for trainees in ophthalmology.
Dr Fung’s exceptional ability was quickly recognized in the early years of his training and as a result he was given the opportunity of performing vitreo-retinal surgery. I would like to think that it was this experience which stimulated his interest in surgery and hence this book. Following up on his first book - “Ophthalmic Clinical Examination; The Sydney Eye Hospital Registrars Manual” this second book has now taken him into his sub-specialty field of vitreo-retinal surgery. It breaks new ground for it is the first textbook on the subject directed to ophthalmologists in training. As well it will serve as an excellent reference book for non vitreo-retinal ophthalmologists. It is a most comprehensive textbook covering all facets of vitreo-retinal surgery up to the procedures of endoscopic vitrectomy and endocylophotocoagulation. There is also a large section on scleral buckling.
In each chapter he highlights the most important “pearls”. The text is easy to read and extremely well set out with ample illustrations. It will be very helpful for trainees to read in conjunction with their vitreo-retinal surgical terms.
I have no hesitation in recommending this to all trainee ophthalmologists.
John Gregory-Roberts MBBS, BSc, FRANZCO, FRACS, FRCOphth
Head Vitreoretinal Unit
Sydney Eye Hospital, Sydney, Australia
Honorary Governor and Past President of the University of Sydney Medical School Foundation
Life Governor and Vice-President of the Royal Institute for Deaf and Blind Children, North Rocks, Sydney
PREFACE
This book has been written for anyone interested in learning vitreo-retinal surgery. It has particularly been targeted at residents, registrars, fellows and those commencing their career, whom I encourage to bring this book with them into the operating room. It aims to provide a clear, concise, ‘step-by-step’ guide to vitreo-retinal surgery.
Nothing can replace actual operating time in the development of surgical skills. Trainees should not expect to be able to perform a vitrectomy or scleral buckling procedure based solely on reading this book. Nevertheless, this book should make the surgical experience less stressful, more rewarding and enhance the educational value of time spent with more senior surgeons.
There is no single method for operating on an eye. The approach herein has provided a practical, simple and time efficient method for me, but in no means is it the only way. As often as possible, I have attempted to provide several surgical options with their advantages and disadvantages. I encourage you to use this book as a guide, question each step, and perfect your own vitreo-retinal surgical techniques. Most of all, I hope that this book helps you enjoy vitreo-retinal surgery as much as I do.
Professor Adrian T Fung
All rights reserved. No part of this publication which includes all images and diagrams may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the authors, except in the case of brief quotations embodied in critical reviews and certain other noncommercial uses permitted by copyright law.
Westmead Eye Manual
This invaluable open-source textbook for eye care professionals summarises the steps ophthalmologists need to perform when examining a patient.
