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Microincision vitrectomy surgery: The latest step in minimally invasive ophthalmic techniques
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 Richard L. Lindstrom |
Microincision vitrectomy surgery (MIVS) now joins microincision cataract surgery (MICS) and microincision glaucoma surgery (MIGS) in our continuous quest to enhance the benefit and reduce the risk of the surgical procedures in ophthalmology. The “M” and “I” can stand for microincision or minimally invasive. In either case, the procedures are associated with sutureless incisions, less induced astigmatism, less inflammation, less bleeding, reduced surgery times and more rapid visual rehabilitation for the patient.
For most procedures, there is also a meaningful improvement in intraoperative control of every step. Along with the development of less invasive surgical procedures is an increased utilization of ambulatory surgery centers over hospital operating theaters and, in many cases, office-based surgery over ASCs. As surgery becomes faster and the postoperative recovery quicker with a lower morbidity, patients are able to return to full activity faster and the number of postoperative visits is reduced. Less time in a less expensive operating room, fewer postoperative visits, fewer days of work missed and fewer complications translate into another major advantage for society as a whole: less cost. Because all key parties — including the surgeon, the patient, the third-party payer, the employer and the caretaker family — benefit, it is certain that we and the industry we partner with to enhance the art and science of ophthalmic surgery will continue to invest in the advancement of microincision/minimally invasive surgery.
The future I envision will include a surgical workstation with magnified 3-D optics, femtosecond lasers to make incisions that are perfect in location, size and configuration, robotic assistance to allow even greater precision of delicate intraocular manipulations, and sustained-release drug delivery to not only reduce postoperative inflammation and infection, but also enhance wound healing. These advanced surgical workstations will still require significant training and both cognitive and procedural skill, but their wide adoption will also generate a more reproducible outcome from one surgeon to another.
This improved reproducible outcome for all surgeons will be a great benefit to the 6 million or more eyes that undergo surgery in America each year, and the more than 20 million eyes worldwide. In addition, the enhanced productivity will allow us to maximize the benefit of our soon to be scarcest resource worldwide: the fully trained, experienced ophthalmic surgeon.