Dr Hemanth Murthy wins EURETINA video competition

[caption id="attachment_5203" align="alignnone" width="750"] Jan Van Meurs, presenting the first prize in the EURETINA Video Competition Awards to Hemanth Murthy[/caption] Dr Hemanth Murthy’s prize-winning video entry in the EURETINA Video Competition Awards, gave an elegant example of the surgical techniques that can be successfully employed to induce posterior vitreous detachment in vitrectomy surgery. While PVD can usually be induced with cutter suction, there are some challenging situations where alternate methods of PVD induction may be necessary, such as young patients with adherent posterior hyaloid, cases of high myopia with frequent vitreoschisis, and vascular proliferations on the posterior hyaloid face. In the video, Dr Murthy showed an effective method for breaking the surface tension or forces of adherence between the posterior hyaloid and retina, using a pick or spatula as well as the use of active suction using a soft tipped cannula. The key to the technique is the use of a fine polythene film on a moist smooth surface. If suction is attempted, it appears inadequate to break the bond, noted Dr Murthy. However, if a fine opening is made in the polythene film, the same suction successfully separated the posterior hyaloid and retina. Using this approach, Dr Murthy and co-workers were able to achieve PVD induction in cases involving younger patients. The use of triamcinolone enabled easy identification of the posterior hyaloid, and a pick or spatula was then used to create a small opening. Active suction with a soft-tipped cannula then achieved PVD. In cases of high myopia, however, the posterior hyaloid was irregularly adherent and a forceps was required in order to peel the hyaloid, which was adherent to the retina. In cases with vascular proliferations, it was necessary to segment the hyaloid face around the proliferations and remove the free hyaloid, thereby proving greater safety. Second prize went to Vishal Agrawal, India, for ‘The last hurdle – comprehensive management strategies of posterior hyaloid removal in pars plana vitrectomy (PPV) for paediatric retinal detachment’. Posterior vitreous detachment also featured strongly in Dr Agrawal’s video, which demonstrated a step-by-step approach to inducing PVD in paediatric rhegmatogenous retinal detachments. The video highlighted how paediatric rhegmatogenous retinal detachments are vastly different from adult detachments in terms of cause, presentation and final visual outcomes. Traditionally, scleral buckling has been considered the treatment of choice, primarily because of the difficulty in achieving PVD in these cases. Incomplete hyaloid removal leads to recurrences and low success rates. The surgical technique for posterior hyaloid removal described by Dr Agrawal enabled complete vitrectomy and improved attachment rates in complex paediatric cases. The manoeuvres shown are reproducible and the authors were able to induce PVD in all cases performed. Third prize was awarded jointly to Jay Chhablani, India, for ‘Dye extrusion technique in a challenging case of posterior pole retinal detachment’, and Sarah Karam of Spain for ‘How to solve a large size disparity between a big foreign body and the vitrectomy surgery instruments’.  

Tags: posterior vitreous detachment