Vitreoretinal surgery, surgery for conditions that affect the back of the eye, including the macula and retina, has improved significantly in the last 50 years. There have been improvements in surgical precision, safety, and patient outcomes, and Queensland Eye Institute has been at the forefront in adopting new technologies and techniques to provide the best possible patient care.
Evolution of surgical techniques and instrumentation
The transition from traditional 20-gauge systems to micro-incisional vitrectomy surgery utilizing 23-, 25-, and 27-gauge instruments has revolutionized vitreoretinal procedures. These smaller instruments allow for suture-less surgeries, reducing patient discomfort and recovery time. Valved trocars have been instrumental in maintaining intraocular pressure (IOP) during instrument exchanges, minimizing the risk of complications such as suprachoroidal haemorrhage, which can be a devastating potentially blinding complication.
High-speed vitrectomy cutters, with rates exceeding 10,000 cuts per minute, have improved surgical efficiency and safety by reducing vitreoretinal traction. Adaptive fluidics systems further stabilize IOP, enhancing the safety profile of complex surgeries. QEI has lead Queensland in adopting these latest instruments and technologies.
Advances in visualization and imaging
Enhanced visualization technologies have significantly impacted vitreoretinal surgery. Three-dimensional (3D) digital viewing systems provide surgeons with improved depth perception and ergonomics, allowing for more precise manoeuvres. QEI has the first and only 3D visualisation system in Queensland for vitreoretinal operations, the Alcon Ngenuity system. Intraoperative optical coherence tomography (OCT) offers real-time, cross-sectional imaging of retinal structures, aiding in the assessment of surgical outcomes and guiding intraoperative decisions.
Innovations in surgical techniques
New surgical techniques have emerged to address challenging retinal conditions. For macular holes and epiretinal membranes for instance, the use of dyes like brilliant blue has improved the visualization of the membranes, facilitating removal and enhancing surgical outcomes in macular surgeries. Medical silicon oils and gases for retinal detachment and other surgeries have allowed vastly improved outcomes for patients who would have previously gone blind from such conditions.
Integration of Robotics and Artificial Intelligence
The future looks bright for retinal surgery also, with the incorporation of robotics and artificial intelligence (AI) into vitreoretinal surgery an emerging frontier. Robotic systems being developed offer enhanced precision and stability, enabling future surgeons to perform delicate procedures like subretinal injections for Gene Therapy and Inherited Retinal Diseases with greater accuracy. AI algorithms are being developed to assist in surgical planning and intraoperative decision-making, potentially improving outcomes and reducing complications.
Future directions
Looking ahead, the field is exploring gene therapy and retinal prosthetics as potential treatments for retinal degenerative diseases. These innovations aim to restore vision by repairing or replacing damaged retinal cells, offering hope for patients with previously untreatable conditions. QEI is at the forefront of this, doing trials for both age related conditions and inherited conditions for the people Queensland.
In summary, the advancements in vitreoretinal surgery over the past five decades have transformed the field, leading to safer, more efficient, and more effective treatments for a range of retinal diseases. Continued innovation in surgical techniques, instrumentation, visualization, and integration of emerging technologies promises to further enhance patient care in the years to come.