Marta Stevanovic, MD
Mass Eye and Ear, Boston, MA
The Retinal Detachment Symposium Session I at the American Society for Retina Specialists Annual Meeting in Long Beach, California explored both clinical and translational research aimed at improving surgical efficiency, safety, and outcomes. The session was moderated by Dr. Lisa Olmos de Koo MD MBA , Dr. Tom Williamson MD, and Dr. Yusuke Oshima MD PhD.
Taku Wakabayashi MD PhD started the session by discussing his approach to office-based vitrectomy. He described the physical setup of his office, in which the outpatient clinical exam area is adjacent to the procedure room. He performs 25- and 27- gauge pars plana vitrectomy (PPV) and scleral buckle surgeries in his office, relying on local anesthesia. A study conducted by his group assessed the feasibility and outcomes of office-based vitrectomy across three medical centers in Japan. A total of 4377 PPVs were performed, of which 1046 were for rhegmatogenous retinal detachment (RRD) repair. The single surgery anatomic success rate for RRD repair was 96.5%. Importantly, there were no serious intraoperative systemic complications and no cases of endophthalmitis. While his study demonstrated excellent surgical outcomes, Dr. Wakabayashi emphasized the importance of case selection, explaining that the office-based approach may not be appropriate for pediatric cases or those requiring general anesthesia, such as severe open globe injuries.
Next, Gaurav Shah MD presented “The Use of Incorrect Intraocular Gas Tamponades During Vitreoretinal Surgery.” He examined 12 closed Ophthalmic Mutual Insurance Company (OMIC) cases to understand the root causes of error for incorrect gas injections. He determined the primary cause of this preventable error to be poor communication. Dr. Shah offered advice on how to mitigate risk, which included keeping the lights on in the operating room, doing a “time out” with operating room staff, documenting gas percentage verbally, repeating important information, having the surgeon draw up the gas or watch a staff member draw gas, and adequately labelling the syringe with mixture percentage.
John Thompson MD then finished the first half of the session with his talk, “Lincoff vs Artificial Intelligence: A Reappraisal of Lincoff’s Rules for Finding the Retinal Tear.” Dr. Thompson designed a machine learning model that predicts retinal tear location in retinal detachments, and compared its accuracy to Lincoff’s rules. Dr. Thompson used a cohort of 1056 of his own retinal detachment surgeries to train the AI model. The machine learning model was able to accurately localize the retinal break in 81-90% of detachments within 1 to 1.5 clock hours. The AI predictions were more accurate than Lincoff’s rules in 95.8% of eyes with 1 tear, 94.5% of eyes with 2 tears, and 96.4% of eyes with 3 tears. This study highlights the growing importance of AI in assisting clinicians in diagnostic and surgical management of retinal diseases.
The second half of the session focused on translational research. Gareth Mercer MD PhD presented his talk, “Minimally Invasive Suprachoroidal Buckling Using a Novel Injector: Preclinical Evaluation in Human Cadaver Eyes.” His team used a proprietary device to inject sodium hyaluronate 2.5% into the suprachoroidal space, with the volumes varying between 0.1 and 0.3 mL at a location between 6 and 15 mm behind the limbus. A successful buckle was obtained in 33 of 34 of the eyes. Dr. Mercer’s study was a pilot to assess this minimally invasive technique of scleral buckling. He hopes to be able to start a clinical trial assessing the safety and efficacy of this approach.
Next, Dr. Eoi Jong Seo MD PhD presented, “Pre-operative OCT Biomarkers of Outer Retinal Alteration in Rhegmatogenous Retinal Detachment: Predictors of Postoperative Visual Outcomes.” Outer retinal corrugations are known to developed in detached retinal tissue. Dr. Seo assessed 152 eyes with macula-off retinal detachments of less than two weeks duration. He defined the outer retinal corrugations index (ORCI) as the length of the outer retinal border divided by the length of the inner plexiform layer. The ORCI was the only optical coherence tomography (OCT) biomarker significantly associated with post-operative visual acuity. Furthermore, eyes with post-operative epiretinal membranes or cystoid macular edema had a significantly higher pre-operative ORCI. This study highlights the prognostic importance of the outer retinal corrugations index.
The final talk, presented by Dr. Muhammad Amer Awan MD, was “Evaluation of Macular Perfusion Post-Rhegmatogenous Retinal Detachment Surgery Using Optical Coherence Tomography Angiography: A Systematic Review and Meta-Analysis.” This meta-analysis included 20 studies in which there were a total of 231 macula-on retinal detachments and 455 macula-off detachments. Patients with macula-on detachments had fewer vascular changes, only demonstrating a decrease in parafoveal vascular density of the deep capillary plexus. Patients with macula-off retinal detachments, on the other hand, had post-operative enlargement of the foveal avascular zone (FAZ) in both the superficial and deep capillary plexuses, decreased parafoveal vascular density of the deep capillary plexus, and significantly lower choriocapillaris perfusion density. These persistent vascular changes highlight the importance of timely intervention in macula off retinal detachment cases.
Conclusion
The presentations given at the Retinal Detachment Symposium highlight the innovations taking place in vitreoretinal surgery—from rethinking where and how we operate, to developing strategies to avoid error, to creating tools that assist with clinical decision making and improve surgical approaches. Each talk sparked discussion and commentary from the audience members, who asked insightful questions and shared their own experiences.