Minimally Invasive Vitreous Surgery: 20 Gauge to 27 Gauge Shalabh Sinha
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1Minimally Invasive Vitreous Surgery2
3Minimally Invasive Vitreous Surgery
20 Guage to 27 Gauge
Editor Shalabh Sinha MBBS MS DNB Vitreoretinal Surgeon Krishna Vitreoretinal Surgery and Laser Center Patna, Bihar, India Foreword PN Nagpal
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© 2013, Jaypee Brothers Medical Publishers
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This book has been published in good faith that the contents provided by the contributors contained herein are original, and is intended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the editor specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the editor. Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device.
Minimally Invasive Vitreous Surgery: 20 Gauge to 27 Gauge
First Edition: 2013
Printed at
5Dedicated to
My mother Late Dr Shiv Rani Sinha, whose constant encouragement made me an eye surgeon.
She would have been extremely proud today.
My father, Dr Arun Kumar Sinha an eye surgeon extraordinare whose simple and ethical teaching made me a decent clinician.
My Guru Dr PN Nagpal whose continuing support made me a better retinal surgeon.
All my teachers in school Sherwood College, Nainital
Jawahar Lal Nehru Medical College, Belgaum and CH Nagri Municipal Eye Hospital, Ahmedabad.
Dr Usha H Vyas
Dr Bakulesh Khamar and Dr Manish Nagpal.
My family, most of all my wife Dr Pallavi and my wonderful kids, daughter Aishani and son Pranjal for their love and affection and without whose support this book would never have seen the light of day.6
7Contributors 11Foreword
If we could enhance our sensitivity and listen to the cry of millions of innocent cells, the constituents of conjunctiva, sclera and uveal tissue, who were subjected to invasion by surgical penetration and destruction to create a sclerotomy at 3–4 places in order to get the instruments into the vitreous cavity to perform the vitrectomy and remove the pathology. Those innocent sclerotomy cells were asking (rather crying), “Why We” are being sacrificed. It is the “Basic Principles” of surgery in general that do the surgery to the extent the disease is and not make “Surgical Intervention” a disease. Surgery is trauma. We do attach a religious sanctity to it, but every cut kills cells and invites the same inflammation. Just as street accident trauma. Taking sutures is also traumatic, however, necessary at times.
So, it is the duty of every surgeon to reduce the surgical trauma as much as possible.
Simply putting, the Microincision Vitrectomy Surgery is an attempt to reduce the surgical trauma by reducing the guage of vitrectomy instruments and putting up a sutureless vitreous surgery.
How timely this multiauthor book is to help the vitrectomy surgeon to change from the conventional 20 guage to 23, to 25 and now 27 guage. I must congratulate Dr Shalabh Sinha and his many contributors which needs exercise to edit a book which is the need of the hour.
I am sure it will help convert the new and the other retinovitreous surgeons, who are sitting on the fence to change over to minimally invasive vitreous surgery (MIVS).
Retina Foundation
Shahibaug Underbridge
Ahmedabad, Gujarat, India12
Like the turning spokes of a wheel, change is permanent. Similarly, the field of ophthalmology has been constantly changing and adapting to the needs of the surgeons and their patients. Better engineering skills have driven machines to perform tasks unimaginable 20 years ago. We, as eye surgeons, and as retinal surgeons, have been gifted with a remarkable opportunity to live in a time, when surgical finesse is at its upward slope. Recent advances in microinvasive technology have provided us with the ability to do justice to our patients and aid in their early visual recovery. The coming years will be even more interesting with refinements in current technology.
This book was conceived three years ago, at the All India Ophthalmic Conference (AIOC), Kolkata, West Bengal, India, where I had felt the need for a book on Minimally Invasive Vitreous Surgery: 20 Gauge to 27 Gauge. I am extremely grateful to all the contributors of this book, who have tried their best at guiding the young retinal surgeons at the nuances of small gauge vitreous surgery. An enclosed interactive DVD would further aid the learning process for a young retinal surgeon.
Furthermore, I request all readers to help us in improving upon this maiden effort, by phone, email or in person. Any shortcomings in the book, I humbly beg pardon for.
Shalabh Sinha14
I express my sincere gratitude to all the contributors for this book.
I thank Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director) and Mr Tarun Duneja (Director-Publishing), and the entire team of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, who have been extremely patient with me.