Dr Hemanth Murthy, Bangalore, India, wins top European retina prize
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.
Dr Murthy is Consultant and Vice-president, Retina Institute of Karnataka, Bangalore, Karnataka, India.
In his video Dr Murthy demonstrated that 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.