About

To the three favourite girls in my life: Cynthia, Aria and Elodie.

Although the first modern vitrectomy was performed over 50 years ago, between the prevalence of scleral buckling and the lack of modern camera capabilities, most retinal surgery had been relegated to the visual vacuum of a darkened operating room suite - ennui for all but the surgeon and assistant - until the last decade or so. Sharing information challenged the imagination and was necessarily limited. Once suitable cameras and editing options were developed, finally surgical techniques and experiences could be revealed in a more vivid and meaningful fashion. Dr. Fung pioneered that media with his first edition of the Vitreoretinal Surgery Online work. I am privileged to introduce the second edition which presents the virtual explosion of new techniques and expanded, newer indications for vitreoretinal surgery, assembled with the necessary assistance of multiple new senior editors.

This editorial team has assembled a magnificent and comprehensive collection of videos with step by step written explanations and key illustrations for the full spectrum of vitreoretinal surgical procedures. One of the hallmarks of current vitreoretinal surgery is that there are now often multiple ways to achieve the same objectives – bordering on too many it seems at times - with a dizzying array of options not without some differing opinions as to their relative merits. This expanded, second edition gives fair and balanced attention to provide the reader with the full gamut of these options from some 93 contributors from the world over. The strategic screen shots which accompany the explanation of the videos is a format that enhances the readers’ grasp of techniques that they may have never tried or seen, lending a cornucopia of pearls and tips to maximize effective surgical results.

This is a must-see resource for the trainee and the experienced vitreoretinal surgeon alike, and the digital format makes it available at our fingertips throughout the entire world! Kudos for making a great work better!

William E. Smiddy, MD

M Brenn Green Professor of Ophthalmology
University of Miami Miller School of Medicine
Bascom Palmer Eye Insititute
Miami, FL

It has been ten years since the First Edition of “Vitreoretinal Surgery for Trainees” was published. That textbook was a collation of my first-hand experience in vitreoretinal surgery, written in practical language that provided step-by-step instructions for Ophthalmology Fellows learning the art of this science. This Second Edition has two major advances. Firstly, it has been made available open-source and online, so that it is available to any surgeon, anywhere in the world. We hope that that it will be referenced frequently in the operating room. The online format also allows for future updates of this living resource, and comments are always welcome using the link on the homepage. Secondly, this has been an international collaboration with 91 authors worldwide, including surgeons who are respected leaders in their field and their Fellows. Over 20 new chapters have been added, with new Figures and the addition of surgical videos. We hope that you will learn as much from this textbook as we have enjoyed writing it and continue to advance the knowledge of this wonderful subspecialty.

Professor Adrian T Fung on behalf of the Editorial Team

Nicholas Yannuzzi
Sebastian Waldstein
Nimesh Patel
Kenneth Lee
Raymond Guan

DEDICATION

To Andrew, Bill, David, Dave and Patrick,

for your time, patience, guidance, generosity and friendship, and for teaching me the secrets of vitreo-retinal surgery

Dr. Adrian Fung has written an exceptional textbook covering all facets of vitreo-retinal surgery. The text is specifically designed for vitreo-retinal surgeons in training. In the section on retinal detachment, he reviews the surgical options which include pneumatic retinopexy, scleral buckling and vitrectomy surgery with or without a scleral buckle. He discusses the important factors in deciding which procedure is best for the particular patient. The textbook also reviews surgical management of proliferative diabetic retinopathy, epiretinal membrane peel, macular hole repair, vitreoretinal traction syndrome, pars plana lensectomy, intraocular lens removal with secondary lens implantation, penetrating eye injuries, supra-choroidal haemorrhage, endophthalmitis, vitreous biopsies and submacular haemorrhage.

As retinal specialists, every surgical case is unique and presents a puzzle, usually technical or intellectual, that must be considered and solved. There are usually many different approaches to addressing a particular surgical task but ultimately, our training and recent successes define our approach. Surgical retina is an apprentice-based learning endeavour that is not grounded in well-conducted clinical trials or systematic reviews of the literature. The procedures that have been developed to restore sight in the setting of posterior segment pathology are the result of decades of incremental refinements of both technique and instrumentation. This is the basis on which this book has been created.

In this book you will find step-by-step descriptions of all the components of vitreo-retinal surgery. Techniques are presented in a practical and well-organized fashion and numerous helpful “pearls” and “pitfalls” are highlighted throughout. This is an uncommon approach to a surgical book, but one that fellows and surgeons early in their careers will find very useful, especially as a quick review prior to undertaking specific procedures. His excellent photographs are also very useful in understanding the surgical techniques applied.

Dr. Fung is to be congratulated on producing a comprehensive, detailed manual outlining the repair and management of all forms of vitreo-retinal disease.

David A.L. Maberley, MD, MPH, FRCSC

Professor of Ophthalmology Head, Retina Division
Department of Ophthalmology and Visual Sciences University of British Columbia, Vancouver, Canada

William H. Ross, MD, FRCSC

Clinical Professor of Ophthalmology Former Head, Retina Division
Department of Ophthalmology and Visual Sciences University of British Columbia, Vancouver, Canada Chairman Retina Division
Providence Health Care, Vancouver, Canada

It gives me great pleasure to write this foreward to Dr. Adrian Fung’s new textbook, not only because the author underwent his ophthalmology registrar (residency) training at the Sydney Eye Hospital but because this book makes a significant contribution to the material available for trainees in ophthalmology.

Dr Fung’s exceptional ability was quickly recognized in the early years of his training and as a result he was given the opportunity of performing vitreo-retinal surgery. I would like to think that it was this experience which stimulated his interest in surgery and hence this book. Following up on his first book - “Ophthalmic Clinical Examination; The Sydney Eye Hospital Registrars Manual” this second book has now taken him into his sub-specialty field of vitreo-retinal surgery. It breaks new ground for it is the first textbook on the subject directed to ophthalmologists in training. As well it will serve as an excellent reference book for non vitreo-retinal ophthalmologists. It is a most comprehensive textbook covering all facets of vitreo-retinal surgery up to the procedures of endoscopic vitrectomy and endocylophotocoagulation. There is also a large section on scleral buckling.

In each chapter he highlights the most important “pearls”. The text is easy to read and extremely well set out with ample illustrations. It will be very helpful for trainees to read in conjunction with their vitreo-retinal surgical terms.

I have no hesitation in recommending this to all trainee ophthalmologists.

John Gregory-Roberts MBBS, BSc, FRANZCO, FRACS, FRCOphth

Head Vitreoretinal Unit
Sydney Eye Hospital, Sydney, Australia
Honorary Governor and Past President of the University of Sydney Medical School Foundation
Life Governor and Vice-President of the Royal Institute for Deaf and Blind Children, North Rocks, Sydney

PREFACE

This book has been written for anyone interested in learning vitreo-retinal surgery. It has particularly been targeted at residents, registrars, fellows and those commencing their career, whom I encourage to bring this book with them into the operating room. It aims to provide a clear, concise, ‘step-by-step’ guide to vitreo-retinal surgery.

Nothing can replace actual operating time in the development of surgical skills. Trainees should not expect to be able to perform a vitrectomy or scleral buckling procedure based solely on reading this book. Nevertheless, this book should make the surgical experience less stressful, more rewarding and enhance the educational value of time spent with more senior surgeons.

There is no single method for operating on an eye. The approach herein has provided a practical, simple and time efficient method for me, but in no means is it the only way. As often as possible, I have attempted to provide several surgical options with their advantages and disadvantages. I encourage you to use this book as a guide, question each step, and perfect your own vitreo-retinal surgical techniques. Most of all, I hope that this book helps you enjoy vitreo-retinal surgery as much as I do.

Professor Adrian T Fung