VRSI Insights on Retinal Errors and the Use of Glue

We all make mistakes and one of the best ways we can improve ourselves is by learning from our errors. It’s a normal part of life, and even though ophthalmology is bursting full of next-level geniuses, sometimes mistakes do happen. What’s important is two key factors: Firstly, how we react to a foul-up (ideally with a calm and humble attitude); and secondly, what we learn from the experience.

This way we can improve as an individual, and everyone from writers to ophthalmic surgeons can become better. With that sentiment in mind, the Vitreo Retina Society of India (VRSI) held When Retinal Disasters Happen and More, a session covering how retina specialists can learn from worst-case scenarios, as well as avoid them. If you work in this field (or any other area of ophthalmology) and want to understand how best to act in medical adversity, this seminar is something you’ll want to watch.

Those sneaky IOLs

The first speaker was Dr. Hussain Khaqan of the Lahore General Hospital in Pakistan, who discussed his work on providing emergency surgery to solve acute issues, including cataracts and displaced intraocular lenses (IOL). One case he covered showed a procedure to retrieve an errant IOL, which was difficult as it included a risk of seriously damaging the patient’s eyesight. However, it was performed successfully with a good visual acuity outcome. Dr. Khaqan also reported on successful procedures he carried out to retrieve a dropped nucleus, again with success.

Just use glue

Dr. Mudit Tyagi, head of Uveitis & Ocular Immunology Services at the LV Prasad Eye Institute in Hyderabad, India, followed with Glue Assisted Vitreoretinal Surgery for Rhegmatogenous Retinal Detachments, which he called GuARD. Dr. Tyagi described how this process uses tamponade agents to provide surface tension across retinal breaks to prevent further fluid flow into the subretinal space. He recommended the use of fibrin glue, which is a mixture of aprotinin, fibronectin, and plasminogen.

Retinal disease and COVID-19

Next up was Dr. Ritesh Narula, a senior consultant in vitreoretina at the Centre for Sight in Delhi, India, who described his facility’s efforts to cope with the added pressure of the COVID-19 pandemic. He stated that several retinal conditions were reported in tandem with infection with the coronavirus, including venous stasis retinopathy and acute macular retinopathy, as well as optic neuropathy. He recommends performing fundus examination in post-COVID-19 patients, especially in those who had been on prolonged steroids or with visual symptoms like blurred vision or floaters.

Mapping the best IOL location

Last but by no means least, was Dr. Vishal Agrawal, an ophthalmologist based in Jaipur, India, who described how the different techniques used to glue an IOL are best summed up by the old maxim “all roads lead to Rome.” Dr. Agrawal emphasized that the best location to place an IOL is always in the capsular bag and that intraoperative complications, subluxated lenses and congenital conditions can lead to insufficient capsular bag support, so these are issues that clinicians should be mindful of.

With regard to the glue that leads to the Italian capital, he stated that sutureless IOL fixation techniques are the future of secondary IOLs as they offer reduced morbidity and decreased postoperative adjustment.

Like many of our Expo events this particular session ran overtime — which to be honest, we’re flattered about, as it highlights just how engaged the participants were, so kudos! We wanted to highlight the presenters in particular, but also, shout outs to moderator Dr. Subhendu Boral for leading the discussion at the end of the event, as well as Drs. Shobhit Chawla, Raja Narayanan, and Dr. Anand Rajendran for their spirited contribution.

Editor’s Note: A version of this article was first published in Issue 3 of CAKE & PIE POST, C&PE 2021 Edition. The CAKE & PIE Expo 2021 was LIVE on June 18-19. All sessions are available on demand until July 19 at upon login.

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