AAO 2024: Management of the vitreous for the anterior segment surgeon

Vikas Chopra, MD, from the Doheny Eye Institute of UCLA, caught up with the Eye Care Network at this year's AAO meeting held in Chicago, Illinois. He shared how technology has advanced ophthalmic surgery over the years and how hands on sessions at the meeting allow surgeons to train for rare complications that can arise during routine surgeries.

Video Transcript:

Editor's note: The below transcript has been lightly edited for clarity.

Vikas Chopra, MD: Hi, I'm Vik Chopra. I'm at Doheny UCLA in Los Angeles, in Pasadena, California, and I'm here at the Academy teaching 2 different courses. The first one that I'm going to talk about today is the management of vitreous in anterior segment surgery. This is a really important topic, just because it's a complication that is infrequent but has to be managed very well during surgery. Cataract surgery is the most common surgery that's done in the world now for any types of surgery, especially for eye surgeries. And then when someone has a complication like vitreous loss, the management of that is very, very important. So the great thing about this course is that there's a didactic followed by wet lab. And what you're doing is you're training people from all spectrums, doctors who have new to the training, versus people who've already been in the business for some time and want a refresher course. It's a one-on-one course that we taught where we're sitting down with a particular ophthalmologist using dry lab. So these are eyes that are, you know, fake eyes, along with wet lab, which is pig eyes, to learn how to do management of vitreous during anterior segment surgery. I think it was very useful for the the participants, as well as we learned something from the questions that the the attendees asked. So that was a great to be part of that course.

Yeah, so technology is an integral part of you know, in the last 20 years as a clinician, I mean, advancements are significant. The most important advancements are essentially of what's called anterior chamber management, meaning the fluidics are so much more advanced these days. You can set a specific intraocular pressure that is determined to be in the eye, and the machine will do that for you. So in the past, you had to have a bottle that you would move up and down to keep the eye more inflated or deflated, depending on what's happening in the eye. But these days, you set actually a parameter in the machine, and within milliseconds, it'll keep it at that exact parameter. So technology has been absolutely our friend. It's made surgery safer, quicker, and definitely much more predictable.

Essentially, you know, for anterior segment surgery, we don't want to see vitreous, so if we see vitreous, typically, it's considered a complication. But you have to learn to manage the vitreous. That's the vitreous is typically in the posterior segment of the eye. Whenever it moves to the anterior segment, you need to manage it. But the issue really is, in many of the things we do, is that we encounter these complications so infrequently that you lose either the practice of how to manage it or the ability because you don't do it well enough. So if you can learn the pearls, you know, in a lecture and followed by in the wet lab, then you take those home, and if you have the complication, you've gone through it once before, and you can, you know, manage that case much, much better.