Advances in the tools and techniques of vitreoretinal surgery

ABSTRACT

Introduction

The field of vitreoretinal surgery has shown rapid technological improvements in the past decade. There has been tremendous progress in our capabilities of viewing the retina and the vitreoretinal interface during surgery.

Areas covered

In this review, a comprehensive list of novel techniques and instrumentation in pars plana vitreous surgery have been elucidated. The review includes various enhancements in the visualization systems including operating microscopes and 3D heads-up display systems. Viewing systems such as endoscopic vitrectomy have been described. New vitrectomy machines with advanced duty cycles, vitrectors with modified designs and higher cut rates, and intraocular instruments such as endoilluminators and lasers have been described. The review also covers new dyes, tamponade agents, as well as novel surgical procedures including submacular surgeries, retinal transplants, and gene therapies.

Expert opinion

Novel vitrectomy systems and reduced gauge size of the instruments greatly aid in the management of patients with vitreoretinal diseases. With advances and refinements in this field, there is a great scope of improving the overall structural and functional outcomes of our patients.

KEYWORDS:

• Vitreoretina
• pars plana vitrectomy
• vitrector
• endoillumination
• retinal detachment
• vitreous

Article highlights

• Vitreoretinal surgery is a fast-paced dynamic ophthalmic subspecialty that is heavily dependent on technology and machines.

• One of the key innovations in vitreoretinal surgery is the development of improved visualization systems, including optical microscopes and digital systems such as 3D heads-up visualization.

• Intraoperative optical coherence tomography is a revolutionary technology that allows image-guided vitreoretinal surgery including subretinal biopsy and submacular surgeries.

• Newer vitrectomy probes such as beveled tip cutters with high cut rates per minute have the potential to improve the surgical time, safety, effectiveness, and surgeon comfort.

• Reduced gauge instruments allow precise surgical interventions. The availability of innovative forceps, intraocular scissors, chandelier illumination systems in small gauge further enhance their applicability in various cases.

• Innovative surgical procedures such as subretinal surgeries, autologous retinal transplants, and subretinal gene delivery are currently possible because of latest technological advances.

• In the future, surgeon-friendly, intuitive and machines with deep learning algorithms may become commercially available and further enhance surgeon and patient experience.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose

Additional information

Funding

This paper was not funded.