VITREORETINAL SURGERY

A battle still rages on one of the most interesting and controversial questions in vitreoretinal surgery: whether scleral buckling is still a powerful tool, or whether it should be relegated to the dustbin of medical history. Given the elegance and speed that characterises modern vitrectomy, “the procedure is not practised much anymore except by a small group of enthusiastsâ€, laments the author. This sort of debate might seem curious to anterior segment surgeons. After all, the standard technique for cataract removal, phacoemulsification, has been the unquestionable gold standard for more than a decade. And yet the debate goes on, and will likely do so until the current senior vitreoretinal surgeons, who learned the technique as a mainstay of their treatment of retinal detachments, retire.

Dr Sandeep Saxena and his co-editors have assembled an extensive group of surgeons to help write Vitreoretinal Surgery. Published by Jaypee Highlights, this 430- page text addresses the big debates in the field and introduces the reader to the full extent of posterior segment surgery.

Section 1 is an “Introduction to the Principles, Techniques and Instrumentation of Vitrectomy.†This covers highly specific topics such as long-term intraocular tamponade with silicone oil; chromovitrectomy, or the use of vital dyes for enhanced visualisation of preretinal tissues; and an entire chapter on endophotocoagulation & safe intravitreal injection technique.

Section 2, “Retinal Detachmentâ€, devotes a chapter to each of five broad topics: scleral buckling, pneumatic retinopexy, primary vitrectomy for retinal detachment, proliferative vitreoretinopathy and giant retinal tears. “Diabetic Retinopathy†is the topic considered in Section 3, while “Retinal Vascular Disorders and Inflammation†are covered in Section 4.

Particularly interesting is Section 5, “Macular Surgery.†For example, what are the indications and advantages of ILM peeling after ERM removal? What is the evidence? And which dyes have been shown to be advantageous for this particularly delicate surgical procedure? This section also considers VR surgery for myopic foveoschisis (“the disease is now curableâ€) and submacular haemorrhage removal, which is recommended within seven days of the onset of bleeding.

Sections 6, 7, 8 and 9 cover “Trauma,†“Endophthalmitis,†“Retinopathy of Prematurity†and “Viral Retinitis†respectively. Regarding endophthalmitis, it is sobering to be reminded that the majority (67 per cent) of endophthalmitis cases are iatrogenic, primarily after cataract surgery; the second most common cause is trauma (25 per cent). The results of the Endophthalmitis Vitrectomy Study (EVS) are reviewed here, as are the causative organisms and the antibiotics recommended to treat them.

The management of retinopathy of prematurity is referred to as “a combination of peripheral ablative treatment for the early stages of ROP and vitreous surgery for the later stages.†The section on surgical techniques in viral retinitis primarily focuses on CMV-related retinal detachment in patients with AIDS.

Section 10 is entitled “Miscellaneous.†It covers rather exotic topics such as vitreoretinal surgery for parasitic diseases, but it also reviews the management of a dislocated crystalline lens, dropped nucleus and (sub)luxation of an intraocular lens. The last section discusses eye-conserving surgical treatment methods for intraocular tumours. This book is written in a lucid style and is richly illustrated. Those readers who will likely derive most benefit from this text are residents doing their vitreoretinal surgery rotation, vitreoretinal fellows and earlycareer surgeons looking to brush up on their knowledge before a challenging case.