Trends in posterior segment surgery reviewed

PARIS – Many techniques of vitreoretinal surgery have been developed and improved during the past 30 years through technical advances, said Anselm Kampik, MD, here at the French Society of Ophthalmology meeting.

Dr. Kampik reported that vitrectomy is better than scleral buckling in repair of rhegmatogenous retinal detachment. Vitrectomy is characteristic of a 94% rate of reattachment and only a 3% rate of posterior vitreous detachment. Seventy percent of retinal detachment patients who undergo vitrectomy achieve visual acuity of 20/50 or better postoperatively, Dr. Kampik said.

Also discussed was macular surgery with internal limiting membrane (ILM) peeling for pathologic alterations at the vitreoretinal interface such as macular pucker, vitreomacular traction syndrome and macular holes. For macular pucker, the ILM can be removed without any harm to the retina, Dr. Kampik said. The rate of closure in this type of surgery is high without adjuvants, he said. ILM peeling in macular hole surgery had similar results.

Macular surgery during late stages of diabetes, especially the evolving techniques of surgical intervention for diabetic macular edema (DME), were also discussed. Vitrectomy with ILM peeling for DME is accomplished by staining the ILM with dye, followed by its removal. Dr. Kampik said the dye makes the surgery much easier, but further research is necessary.

For age-related macular degeneration (AMD), subretinal macular surgery can be difficult because of problems in surgical excision of subfoveal choroidal neovascularization. Dr. Kampik discussed the promise of macular rotation surgery for patients with AMD. This procedure has the greatest potential for restoring visual acuity postoperatively, but it also has the highest rate of complications, he said.