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Correspondence on: a model for anterior vitrectomy in real patients: simulation for practical training

Eye (2024)Cite this article

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We read with interest “A model for anterior vitrectomy in real patients: Simulation for practical training” [1]. In this article the authors recognise trainees have historically reported low confidence in managing posterior capsular rupture (PCR) and describe simulating PCR in patients undergoing Removal of Silicone Oil (ROSO). We wish to raise 3 questions.

Is it safe? While the described technique is likely safer than an unplanned PCR during cataract surgery, is it as safe as a standard ROSO through a pars plana approach? Silicone oil is often used in complex retinal detachments and re-detachments and its’ removal is a necessary further procedure. Silicone oil-related complications (endothelial failure (8.3%), glaucoma (15%)) are common, and the additional trauma of an anterior vitrectomy and potential introduction of oil into the anterior chamber in an already compromised eye seems potentially hazardous [2]. Removing oil through a larger wound in a less controlled fashion theoretically may increase the risk of suprachoroidal haemorrhage. The authors present their proposal as an opportunity to gain experience placing a 3-piece IOL in the sulcus. Sulcus placement is an excellent option in the presence of posterior capsular compromise, but is it as safe and predicable as ‘in the bag’ placement? [3] Such proposals would represent a considerable deviation from standard practice for most vitreoretinal surgeons and therefore evidence of comparative safety is needed.

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References

  1. Wilde C, Awad M, Foss A, Panos GD, Dua H. A model for anterior vitrectomy in real patients: Simulation for practical training. Eye (Lond). 2024;38:1405–6. https://doi.org/10.1038/s41433-024-02925-5.

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  2. Valentin-Bravo FJ, Garcia-Onrubia L, Andres-Iglesias C, Valentín-Bravo E, Martín-Vallejo J, Pastor JC, et al. Complications associated with the use of silicone oil in vitreoretinal surgery: A systemic review and meta-analysis. Acta Ophthalmol. 2022;100:e864–80. https://doi.org/10.1111/aos.15055.

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  3. Martin RG, Sanders DR, Souchek J, Raanan MG, DeLuca M. Effect of posterior chamber intraocular lens design and surgical placement on postoperative outcome. J Cataract Refract Surg. 1992;18:333–41. https://doi.org/10.1016/s0886-3350(13)80067-3.

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Authors and Affiliations

  1. Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK

    Alasdair I. Simpson, Jennifer Hind & David Lockington

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  1. Alasdair I. Simpson
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  2. Jennifer Hind
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  3. David Lockington
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AS had the idea and principally wrote the letter, JH and DL provided senior support and edited the manuscript.

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Correspondence to Alasdair I. Simpson.

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Simpson, A.I., Hind, J. & Lockington, D. Correspondence on: a model for anterior vitrectomy in real patients: simulation for practical training. Eye (2024). https://doi.org/10.1038/s41433-024-03296-7

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