Deliberating important topics

Delegates enjoy debates on cryo-therapy versus laser in vitrectomy and investigation in uveitis

Leigh Spielberg

Posted: Monday, September 9, 2019

The Amsterdam Retina Debate has become a veritable institution within EURETINA, hosting experts to deliberate important topics that have no clear right or wrong answer.

Chaired by Professor Sarit Lesnik-Oberstein of the Netherlands, this year’s debate, at the 19th Annual EURETINA Congress in Paris, treated delegates to two separate battles. The first concerned the relative merits of cryo-therapy versus laser in vitrectomy. The second considered the extent to which extensive investigation is needed in uveitis cases.

Arguing against the statement, “Cryo-therapy is Superior to Laser in Vitrectomy”, Paul Sullivan, Moorfields Eye Hospital, London, UK, started with a 77% majority in the pre-debate voting.

“Numerous randomised controlled trials have shown no significant difference between cryo-therapy and laser, but does this mean that they are equally effective?” asked Dr Sullivan.

To make the case for laser, Dr Sullivan focused on what he considers its superior safety profile. “Retinal laser affects only the retina and the underlying retinal pigment epithelium,” he said. “In contrast, cryo-therapy damages the conjunctiva, sclera, choroid retina and can even reach into the vitreous.” Indirectly, cryo-therapy promotes inflammation, which might increase the risk of PVR.

Rumana Hussain, St Paul’s Eye Unit, Liverpool, UK, argued against the topic’s current conventional wisdom. “Laser can’t be used in the presence of subretinal fluid, it is difficult to use for blonde fundi, limiting its use.” She quoted Dr Sullivan’s own book on vitreoretinal surgery, in which he wrote that “cryo-therapy is safe and effective”.

Despite a lively, entertaining and well-researched defence of cryo-therapy, the audience stuck with their pre-debate opinions and selected laser as the superior modality for retinal treatment.

The second debate, “Uveitis Always Needs Extensive Investigation”, pitted Lisa Faia, Associated Retinal consultants, Michigan, USA, against Emanuel de Carvalho, Moorfields Eye Hospital, London, UK.

Prior to the debate, delegates voted against the notion that uveitis always needs to be extensively investigated. Dr Faia argued convincingly against the “shotgun approach”, stating that “there is no one set work-up for the uveitis patient, and testing for each individual should be focused and based on the examination, history and symptoms”. She cited stress to the doctor, patient and health care system that could be incurred by unnecessary testing. Dr de Carvalho maintained that the relative rarity of uveitis warranted a maximal approach to get to a correct diagnosis. “Otherwise, we risk missing severe diseases in individual patients.” The audience agreed.