Retina & Vitreous Surgery: A Practical Guide to Theory, Practice and Management Subhendu Kumar Boral, Suber S Huang
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FM1Retina & VITREOUS SURGERYFM2
FM3Retina & VITREOUS SURGERY A Practical Guide to Theory, Practice and Management
Editor-in-Chief Subhendu Kumar Boral MD DNB (Ophthalmology) Senior Vitreoretina Consultant Disha Eye Hospitals and Research Centre, Kolkata West Bengal, India Guest Editor Suber S Huang MD MBA CEO, Retina Center of Ohio Cleveland, Ohio, USA Chair, National Eye Health Education Committee National Eye Institute, National Institutes of Health, Bethesda, USA Associate Secretariat Research, Regulatory and Scientific Affairs American Academy of Ophthalmology San Francisco, California, USA Board of Directors, American Society of Retina Specialists Former President, American Society of Retina Specialists Forewords Suber S Huang Hem Kumar Tewari
FM4
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Retina & Vitreous Surgery—A Practical Guide to Theory, Practice and Management
First Edition: Digital Version 2017
9789385999703
FM5Dedicated to
My beloved parents Shib Chandra Boral and Sikha Boral
whose sacrifice for me is beyond imagination
and
Soma Boral, my better half, who constantly inspired and
supported me to complete this vast workFM6
FM7Foreword
It is an extraordinary time in the field of retina.
In the last 20 years, we have witnessed the maturation of the specialty of retina. From the infancy of our field, we have recognized that our most common blinding diseases have complicated pathophysiology and often require surgery to relieve vitreoretinal traction, to treat diseased retina, to remove opacity, to reattach the retina and to treat complications of trauma and other eye disease. Innovative changes in retina in diagnostics, surgical instrument design and technique have improved outcomes and have made surgery better tolerated, faster and more available to more people than at any time in history. Dr Boral's textbook is a practical guide to important aspects of the clinical practice of retinal surgery. Its thoughtful and organized layout guides a logical approach to modern retina and vitreous surgery. The chapters of small incision surgery is particularly fascinating and useful for expert and beginning surgeons alike. Like our field, the surgical armamentarium continues to grow and will likely extend to even more elegant macular surgery and gene therapy. Retina and Vitreous Surgery is designed to be used as an everyday reference, a scalpel that not only sharpens the reader's surgical skills, but will also serve as a solid reference to which one can return time and again. This book is a unique, fascinating and masterful addition to the literature on retina surgery. Seeing is believing. Retina surgery is the most scientific of the arts and the most artistic of the sciences.
Suber S Huang MD MBA
CEO, Retina Center of Ohio
Cleveland, Ohio, USA
Chair, National Eye Health Education Committee
National Eye Institute, National Institutes of Health, Bethesda, USA
Associate Secretariat
Research, Regulatory and Scientific Affairs
American Academy of Ophthalmology
San Francisco, California, USA
Board of Directors, American Society of Retina Specialists
Former President, American Society of Retina SpecialistsFM8
FM9Foreword
In ophthalmology, the subspecialty of retina-vitreous is ever-changing. In the last few years, retina-vitreous surgery has tremendously changed and improved in technology and techniques and has revolutionized. This has led to improved patient care.
Earlier, eyes which were thought to be beyond repair are being salvaged today. Dr Subhendu's book is a kind of practical lucid book, comprising on complete text of surgical retina, what a retina surgeon should know in their practice field, as well as practical surgical steps with beautiful colored photographs and discussions on preoperative, intraoperative and postoperative complications step-by-step, also how to prevent it. The best part is HD animations with illustrations and discussions on the management of intra- and postoperative complications supported with good photographs. Subhendu was my student in his residency days, he used to assist me. My heartfelt congratulation goes to him for this commendable effort and I think this book will help all retina colleagues, especially fellows in retina.
Hem Kumar Tewari MBBS MD (AIIMS)
Professor & Former Chief
RP Centre, All India Institute of Medical Sciences
New Delhi, India
Senior Consultant
Eye Specialist and Vitreoretinal Surgeon
Sir Ganga Ram Hospital and Centre for Sight
New DelhiFM10
FM11Preface
Surgical Retina has changed considerably over the last ten years with the introduction of minimally invasive approach, newer vitrectomy machines with innovative cutter technologies, newer techniques, wide-angle visualization system, improved endoillumination options, changing paradigm to manage many complex surgical pathologies. Introduction of new OCT also made a revolutionary change in approaches. Conversion from 20 gauge to 23, 25 and 27 gauge. Minimally invasive vitreous surgery (MIVS) was also for better postoperative comfort and better outcome for the patients. I have discussed and highlighted the current trends in the MIVS.
The key challenges in the subspecialty of vitreoretina are that it requires dexterity, extensive surgical training as well as knowledge and sound rational reasoning during routine as well as emergency intraoperative challenges. In my residency and fellowship days, I always felt the necessity for a practical lucid book on surgical vitreoretina, especially for the students and fellows in this subspecialty. This book is a complete textbook on surgical vitreoretina with a new concept, comprising of complete texts of surgical procedures, theoretical background as well as practical surgical steps with case discussions, plenty of illustrations, animations and colored intraoperative distinct photographs of each surgical steps. It also discusses management of intra- and postoperative complications. This is just an amalgamation of theories and practicals on retina and vitreous. I think this effort will provide a very complete practical guide in the day-to-day practice, with a background of theory and to manage the complications. I hope this book will help the vitreoretinal surgeons in recapitulation of knowledge, as well as updating it, encourage and illuminate the young learning surgeons initiating in this specialty and to manage complications in more skilful manner.
Subhendu Kumar BoralFM12
FM13Acknowledgments
This book on surgical vitreoretina is for the students and fellows who are dedicating themselves to learn vitreoretina. I acknowledge my teachers of Dr RP Centre for Ophthalmic Sciences, AIIMS, especially Professor HK Tewari, Dr Lalit Verma and Professor Atul Kumar who taught us retina. I am grateful to Dr Debasish Bhattacharya, Chairman, Disha Eye Hospitals, Kolkata, West Bengal, India, as well as President of All India Ophthalmic Society and Dr Tushar K Sinha, Head of the Department of Vitreoretina, whose constant suggestions and encouragement made me to complete this book. I am grateful to all doctors of Disha Eye Hospitals, especially Dr Arnab Das, Dr Santanu Mandal, Dr Santanu Mitra, Dr Sumali Deb, Dr Suchanda Sar, Dr Abhijit Banerjee and Dr Arup Bhaumik for their cooperation. I am thankful to Dr Ayan Mohanta who initiated the high definition recording system in our hospital. I am ever grateful to Dr Sunil Parikh whose surgical approach and dexterity tuned me a lot.
My sincere gratitude goes to eminent surgeon Dr Suber S Huang, CEO, Retina Center of Ohio, Former President, American Society of Retina Specialists (ASRS) who has committed himself as the ‘Guest Editor’ in my book as well as wrote the foreword for this book after going through my project. His blessings, constant encouragements and valuable suggestions have enriched my project. He especially advised me to include the chapter “How to setup a vitreoretinal surgery theater” to have a brief concise idea to start for a neoretinologist.
I sincerely acknowledge all the renowned authors as well as the publishers of the following books and references from where I have compiled the necessary materials to complete this book:
  1. Peyman GA, Meffert SA, Conway MD. Vitreoretinal Surgical Techniques (Second edition).
  2. Ryan SJ. Retina (Second edition).
  3. Wilkinson CP, Rice TA. Michaels Retinal Detachment (Second edition).
  4. Byrne SF, Green RL. Ultrasound of the Eye and Orbit.
  5. Endophthalmitis Vitrectomy Study. Arch Ophthalmol. 1995.
  6. Eckhardt C. Combined phaco-vitrectomy. Retina Today.May/June. 2013;36-38.
  7. Agarwal A. Glued IOL: Glued Intrascleral Haptic Fixation of a PCIOL. New Delhi: Jaypee; 2012.
  8. Charles S. The interface vitrectomy technique. Retina Today; Jan/Feb 2010.
  9. Lois N, Wong D. Complications of Vitreoretinal Surgery.
And many more. In case, if I have excluded to mention any reference, I hope the author will consider my due acknowledgement.
My sincere appreciation goes to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President), Mr Tarun Duneja (Director-Publishing) and Mr Sabyasachi Hazra (Commissioning Editor) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for their constant support.
Finally, I am greatly indebted to my wife Soma Boral as without her this long journey could never have been completed as well as my sons Sahoran and Sreyansh for gladly tolerating my indifference even in holidays.FM14