About

Editors & Authors

Editors

Adrian T Fung

Chief & Founding Editor
Adrian T Fung MBBS MMed (Ophthal Sci) MMed (Clin Epi) FRANZCO

Head, Vitreoretinal Unit, Westmead Hospital
Clinical Professor of Ophthalmology, Macquarie University
Clinical Associate Professor of Ophthalmology, University of Sydney
Sydney, Australia

Nicolas Yannuzzi

Senior Editor
Nicolas Yannuzzi MD

Assistant Professor Clinical Ophthalmology
Department of Vitreoretinal Surgery and Diseases
Bascom Palmer Eye Institute
University of Miami School of Medicine
Miami, FL, USA

Sebastian Waldstein

Senior Editor
Sebastian M. Waldstein MD PHD

Head of Ophthalmology, Mistelbach-Gänserndorf Hospital
Associate Professor of Ophthalmology, Medical University of Vienna
Vienna, Austria

Nimesh Patel

Video Editor
Nimesh A. Patel MD

Instructor of Ophthalmology, Harvard Medical School
Vitreoretinal Surgeon, Massachusetts Eye and Ear Infirmary
Director of Pediatric Retina, Boston Children's Hospital
Voluntary Assistant Professor, Bascom Palmer Eye Institute
Boston, MA, USA

Kenneth Rohan Lee

Figure Editor
Kenneth Rohan Lee MBBS M.Ophthal

Consultant Ophthalmologist and Vitreoretinal Fellow,
Ministry of Health, Malaysia.

Raymond Guan

Copy Editor
Raymond Guan BSc (Bio Med) MD

Sydney, Australia

Authors

Luis Acaba-Berrocal
Luis Acaba-Berrocal

MD

Illinois Eye and Ear Infirmary, University of Illinois Chicago
Chicago, IL, USA

Armin Afshar
Armin Afshar

MD MBA MAS

University of California , San Francisco
San Francisco, CA, USA

Hasenin Al-khersan
Hasenin Al-khersan

MD

Bascom Palmer Eye Institute
Miami, FL, USA

Thomas Arno Albini
Thomas Arno Albini

MD

Bascom Palmer Eye Institute; University of Miami Health
Miami, FL, USA

Sulaiman Alhumaid
Sulaiman Alhumaid

MBBS FRCSC

Bascom Palmer Eye Institute
Miami, FL, USA

Abhilasha Alone
Abhilasha Alone

DNB

LV Prasad Eye Hospital
Hyderabad, India

Rodrigo Anguita
Rodrigo Anguita

MD

Moorfields Eye Hospital
London, United Kingdom

Chandrakumar Balaratnasingam
Chandrakumar Balaratnasingam

MD PhD FRANZCO

Lions Eye Institute; University of Western Australia; Sir Charles Gairdner Hospital
Perth, Australia

Daniel Barthelmes
Daniel Barthelmes

MD PhD EMBA FEBO FMH Ophthalmology & Ophthalmic Surgery

University Hospital; University of Zurich; Save Sight Institute; The University of Sydney
Zurich, Switzerland and Sydney, Australia

Peter J. Belin
Peter J. Belin

MD

VitreoRetinal Surgery, PLLC
Minneapolis, MN, USA

Audina M. Berrocal
Audina M. Berrocal

MD

Bascom Palmer Eye Institute; University of Miami; Miller School of Medicine
Miami, FL, USA

Maria H. Berrocal
Maria H. Berrocal

MD FASRS

CEO Drs. Berrocal & Associates; University of Puerto Rico
San Juan, PR

Gaurav Bhardwaj
Gaurav Bhardwaj

BMed PhD FRANZCO

Westmead Hospital; Liverpool Hospital; Sydney Children's Hospital Network
Sydney, Australia

Kapil Bhatia
Kapil Bhatia

MBBS, MS

C-Mer Dennis Lam Hospital (Shenzhen, China)
Jaipur, India

Anant Bhosale
Anant Bhosale

MD, FICO, FVRS, MRCS(Edin)

Sir Charles Gairdner Hospital and Lions Eye Institute,Perth,Western Australia

Jason Chan
Jason Chung Kit Chan

AFCOphth (HK) MRCSEd(Ophth) MB ChB(CUHK) MPhil(CUHK) BSc (CUHK)

Hong Kong Eye Hospital
Hong Kong, China

Andrew Chang
Andrew Chang

MBBS(Hons) PhD FRANZCO FRACS

Sydney Eye Hospital
Sydney, Australia

Jonathan Chang
Jonathan S. Chang

MD

School of Medicine and Public Health, University of Wisconsin
Madison, WI, USA

Stanley Chang
Stanley Chang

MD

Columbia University Vagelos College of Physicians and Surgeons
New York, NY, USA

Steve Charles
Steve Charles

MD FASRS FACS FICS

Clinical Professor of Ophthalmology, University of Tennessee
Germantown, TN, USA

David Charteris
David Charteris

MBBS FRCOphth

Moorfields Eye Hospital; NHS Foundation Trust
London, UK

Kuan-Jen Chen
Kuan-Jen Chen

MD

Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, College of Medicine, Chang Gung University
Taoyuan, Taiwan

Jay Chhablani
Jay Chhablani

MD

University of Pittsburgh Medical Center
Pittsburgh, PA, USA

Hung-Da Chou
Hung-Da Chou

MD

Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, College of Medicine, Chang Gung University
Taoyuan, Taiwan

Netan Choudhry
Netan Choudhry

MD FRCS(C) DABO

Co-Founder & Medical Director Vitreous Retina Macula Specialists of Toronto; Staff Ophthalmologist Cleveland Clinic Canada; University of Toronto Department of Ophthalmology & Visual Sciences
Toronto, Canada

Mina Chung
Mina M. Chung (Posthumous)

MD

Flaum Eye Institute, University of Rochester
Rochester, USA

Lyndon Da Cruz
Lyndon Da Cruz

MA MBBS PhD FRCOphth FRACO

Moorfields Eye Hospital
London, UK

Bertil Damato
Bertil E. Damato

MD PhD FRCOphth

Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford; Ocular Oncology Service, Moorfields Eye Hospital
London, UK

Marc D de Smet
Marc D. de Smet

Bsc MDCM PhD

Oxular
England, UK

Uday Devgan
Uday Devgan

MD, FACS, FRCS (Glasg)

UCLA / Jules Stein Eye Institute
Los Angeles, CA, USA

Dean Eliott
Dean Eliott

MD

Massachusetts Eye & Ear, Harvard Medical School
Boston, MA, USA

David Fabinyi
David Charles Andrew Fabinyi

MBBS(Hons) FRANZCO

The Royal Victorian Eye and Ear Hospital; University Hospital Geelong; Barwon Health
Melbourne, Australia and Geelong, Australia

Jason Fan
Jason Fan

MD PhD

Bascom Palmer Eye Institute
Miami, FL, USA

Yale L. Fisher
Yale L. Fisher

MD

Bascom Palmer Eye Institute; Weill Cornell Medicine; Vitreous Retinal Macula Consultants of New York
Miami, FL, USA and New York, NY, USA

Blanca C. Florez-Sanches
Blanca C. Flores-Sanchez

MD CHM

Moorfields Eye Hospital; NHS Foundation Trust
London, UK

Harry W. Flynn, Jr
Harry W. Flynn, Jr

MD Professor of Ophthalmology

The J. Donald M. Gass Distinguished Chair in Ophthalmology; Bascom Palmer Eye Institute; UHealth - University of Miami Health System
Miami, FL, USA

Kenneth Fong
Kenneth Fong

FRCOphth FRANZCO

Managing Director, OasisEye Specialists
Kuala Lumpur, Malaysia

Adrian T. Fung
Adrian T. Fung

MBBS MMed (Ophthal Sci) MMed (Clin Epi) FRANZCO

Head, Vitreoretinal Unit, Westmead Hospital
Clinical Professor of Ophthalmology, Macquarie University
Clinical Associate Professor of Ophthalmology, University of Sydney
Sydney, Australia

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Sunir J. Garg
Sunir J. Garg

MD FACS FASRS

Co-Director Retina Research Unit, MidAtlantic Retina; The Retina Service of Wills Eye Hospital, Thomas Jefferson University
Philadelphia, PA, USA

Raymond Guan
Raymond Guan

BSc (Bio Med) MD

Sydney, Australia

Michael J. Heiferman
Michael J. Heiferman

MD

University of Illinois at Chicago
Chicago, Illinois, USA

Hong-Uyen Hua
Hong-Uyen Hua

MD

Cleveland Clinic Cole Eye Institute
Cleveland, OH, USA

Rehan M. Hussain
Rehan M. Hussain

MD

Retina Associates
Chicago, IL, USA

Danilo Iannetta
Danilo Iannetta

MD PhD

Ophthalmology Unit, DIMES, Alma Mater Studiorum, University of Bologna and Sant’Orsola- Malpighi Teaching Hospital
Bologna, Italy

Sana Idrees
Sana Idrees

BA MD

Flaum Eye Institute, University of Rochester
Rochester, NY, USA

Shangjun (Collier) Jiang
Shangjun (Collier) Jiang

BMSc MD

Department of Surgery, University of Calgary
Calgary, Alberta, Canada

Thomas Jenkins
Thomas Jenkins

MD

Wills Eye Hospital
Philadelphia, USA

David Karl
David Karl

MD FRCOphth FEBO

Landesklinikum Mistelbach-Gänserndorf
Mistelbach, Austria

Dvir Koenigstein
Dvir Koenigstein

MD

Ophthalmology Division, Tel Aviv Sourasky Medical Center, Tel Aviv University
Tel Aviv, Israel

Chi-Chun Lai
Chi-Chun Lai

MD

Department of Ophthalmology, Chang Gung Memorial Hospital; College of Medicine, Chang Gung University,
Keelung, Taiwan and Taoyuan, Taiwan

Timothy Lai
Timothy Y. Y. Lai

MD FRCS FRCOphth

Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong; 2010 Retina and Macula Centre, Hong Kong
Kowloon, Hong Kong

Dennis Lam
Dennis Lam

MBBS MD FRCS FRCO

C-MER Dennis Lam Eye Hospital
Shenzhen, China

Kenneth Rohan Lee
Kenneth Rohan Lee

MBBS (Manipal) M.Ophthal (Malaya)

Consultant Ophthalmologist and Vitreoretinal Fellow
Ministry of Health, Malaysia

Anat Loewenstein
Anat Loewenstein

MD, MHA

Director, Ophthalmology Division, Tel-Aviv Medical Center; Associate Dean, Sackler Faculty of Medicine, Tel-Aviv University; President, Israeli Ophthalmological Society
Tel Aviv, Israel

Jiao Lyu
Jiao Lyu

PhD MD

Shanghai Jiaotong University, Medical School, Xinhua Hospital
Shanghai China

David Maberley
David A. L. Maberley

MD MSc (Epid) FRCSC

University of Ottawa
Ottawa, Canada

Andrew Merkur
Andrew Merkur

MD FRCSC

UBC Department of Ophthalmology
Vancouver, British Columbia

William F. Mieler
William F. Mieler

MD

Cless Family Professor and Vice-Chairman; Director Vitreoretinal Fellowship Training, Department of Ophthalmology & Visual Sciences, University of Illinois at Chicago
Chicago, IL, USA

Ronald Milam
Ronald Milam

MD

Cleveland Clinic Cole Eye Institute
Cleveland, OH, USA

Rajeev H. Muni
Rajeev H. Muni

MD MSc FRCSC FASRS

St. Michael’s Hospital/Unity Health Toronto, Vice-Chair Clinical Research, Department of Ophthalmology and Vision Sciences, University of Toronto
Toronto, Canada

Marco Mura
Marco Mura

MD

Professor and Chairman, Department of Ophthalmology, University of Ferrara, Italy
Retina Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia

Roderick O'Day
Roderick O'Day

FRANZCO

Ocular Oncology Service, Moorfields Eye Hospital
London, United Kingdom

Mali Okada
Mali Okada

MBBS MMed FRANZCO

Vitreoretinal Unit, Royal Victorian Eye and Ear Hospital; Centre for Eye Research Australia, The University of Melbourne
Melbourne, Australia

Perach Osaadon
Perach Osaadon

MD MBBS

Sydney Eye Hospital
Sydney, Australia

D. Wilkin Parke III
D. Wilkin Parke III

MD

VitreoRetinal Surgery, PA
Minneapolis, MN, United States

Nimesh Patel
Nimesh A. Patel

MD

Instructor of Ophthalmology, Harvard Medical School; Vitreoretinal Surgeon, Massachusetts Eye and Ear Infirmary; Director of Pediatric Retina, Boston Children's Hospital; Voluntary Assistant Professor, Bascom Palmer Eye Institute
Boston, MA, USA

Tapan P. Patel
Tapan P. Patel

MD PhD

Johns Hopkins University, Wilmer Eye Institute
Baltimore, MD, USA

Aleksandra Rachitskaya
Aleksandra Rachitskaya

MD

Cleveland Clinic Cole Eye Institute
Cleveland, OH, USA

Nishant Vijay Radke
Nishant Vijay Radke

MBBS MD FMRF

Senior Consultant and International Faculty, Chief Executive of International Faculties at C-MER Dr. Dennis Lam Eye Hospital
Shenzhen, China

William H. Ross
William H. Ross

MD FRCSC

University of British Columbia
Vancouver, Canada

Elizabeth J.Rossin
Elizabeth J. Rossin

MD PhD

Massachusetts Eye & Ear, Harvard Medical School
Boston, MA, USA

Paisan Ruamviboonsuk
Paisan Ruamviboonsuk

MD

Clinical Professor of Ophthalmology and Chief of Department, Rangsit University , Rajavithi Hospital
Bangkok, Thailand

Ploysai Rujkorakarn
Ploysai Rujkorakarn

MD

FICO, Department of Ophthalmology, Rajavithi Hospital
Bangkok, Thailand

Ananth Sastry
Ananth Sastry

BSc MD

Duke University School of Medicine
Durham, NC, USA

Adrienne W. Scott
Adrienne W. Scott

MD FASRS

Associate Professor of Ophthalmology, Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine
Baltimore, MD, USA

Nathan L. Scott
Nathan L. Scott

MD MPP

Bascom Palmer Eye Institute
Miami, FL, USA

Jesse D. Sengillo
Jesse D. Sengillo

MD

Bascom Palmer Eye Institute
Miami, FL, USA

Emily Han Shao
Emily Han Shao

MBBS BSc FRCOphth

Sydney Eye Hospital Eddie Donaldson Vitreoretinal fellow
Surrey, UK

William E. Smiddy
William E. Smiddy

MD

University of Miami Miller School of Medicine, Bascom Palmer Eye Institute
Miami, FL, USA

Jayanth Sridhar
Jayanth Sridhar

MD

Associate Professor of Clinical Ophthalmology, Bascom Palmer Eye Institute
Miami, FL, USA

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Parinya Srihatrai
Parinya Srihatrai

MD

FICO, Department of Ophthalmology, Rajavithi Hospital
Bangkok, Thailand

Wee Min Teh
Wee Min Teh

MD, MMed, CCFT

Consultant Ophthalmologist and Vitreoretinal Surgeon
OasisEye Specialists Seremban
Negeri Sembilan, Malaysia

Daniel S.W. Ting
Daniel S.W. Ting

MBBS BSc FRCOphth M Med (Ophth) FAMS, PhD

Singapore National Eye Centre
Singapore, Singapore

Cynthia Ann Toth
Cynthia Ann Toth

MD

Duke University School of Medicine
Durham, NC, USA

Justin Howard Townsend
Justin Howard Townsend

MD

Bascom Palmer Eye Institute, University of Miami Health
Miami, FL, USA

Khoi Tran
Khoi Tran

BPharm MBBS MMed (Ophth) FRANZCO

University of Sydney, University of British Columbia
Gold Coast, Australia

Andrew S.H. Tsai
Andrew S.H. Tsai

MBBS MMed(Ophth) FRCOphth FAMS MCI

Fellow in Surgical Retina, Singapore National Eye Centre
Singapore

Luis E. Vazquez
Luis E. Vazquez

MD PhD

Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
Miami, FL, USA

Sebastian M. Waldstein
Sebastian M. Waldstein

MD PhD

Head of Ophthalmology, Mistelbach-Gänserndorf Hospital; Associate Professor of Ophthalmology, Medical University of Vienna
Vienna, Austria

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John D. Wilgucki
John D. Wilgucki

MD

University of Illinois at Chicago
Chicago, IL, USA

Edmund Y. M. Wong
Edmund Y. M. Wong

MBBS MMed FRCS FAMS

Singapore National Eye Centre
Singapore, Singapore

Wei-Chi Wu
Wei-Chi Wu

MD PhD

Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center; College of Medicine, Chang Gung University
Taoyuan, Taiwan

Nicolas Yannuzzi
Nicolas Yannuzzi

MD

Assistant Professor Clinical Ophthalmology, Department of Vitreoretinal Surgery and Diseases; Bascom Palmer Eye Institute, University of Miami School of Medicine
Miami, FL, USA

Peiquan Zhao
Peiquan Zhao

MD

Department of Ophthalmology, Xinhua Hospital, affiliated to Shanghai Jiaotong University School of Medicine
Shanghai, China

Dedication

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

Foreword

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!

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William E. Smiddy, MD

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

Preface

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.

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Professor Adrian T Fung on behalf of the Editorial Team

Nicholas Yannuzzi
Sebastian Waldstein
Nimesh Patel
Kenneth Lee
Raymond Guan

First Edition

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

FOREWORD

University of British Columbia

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

FOREWORD

Sydney Eye Hospital

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.

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Professor Adrian T Fung

All rights reserved. No part of this publication which includes all images and diagrams may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the authors, except in the case of brief quotations embodied in critical reviews and certain other noncommercial uses permitted by copyright law.

Westmead Eye Manual
This invaluable open-source textbook for eye care professionals summarises the steps ophthalmologists need to perform when examining a patient.

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