Middle Segment Surgery: Entering The Eye Through The Pars Plana To Solve Anterior Segment Surgical Challenges, Mostly Related But Not Limited To Intraocular Lenses

To discuss cases with a special interest of entering the eye through the pars plana to solve anterior segment surgical challenges and complications

Many complex anterior segment problems are best addressed through the pars plana, yet formal training in pars plana techniques is not routinely included in anterior segment fellowships, and refractive considerations are often under-emphasized in vitreoretinal training. We introduced the concept of Middle Segment Surgery (MSS): the surgical management of anterior segment pathology and postoperative challenges via a pars plana approach

Pars plana access improves outcomes in scenarios such as vitreous prolapse in the virgin eye, unicameral eyes, subluxated and dislocated IOLs, retained lens material, aqueous misdirection, and eyes with posterior capsule defects. The paper will also address modern scleral fixation strategies, IOL power calculation when in-the-bag placement is not possible, emerging technologies, and training pathways for anterior- and posterior-segment surgeons adopting Middle Segment Surgery (MSS) techniques, for example: Two to four pars plana vitrectomy ports are placed to manage anterior segment surgical complications. This includes, but not limited to: opacified intracular lenses (IOLs), displaced IOLs, UGH syndromes, CME, visually unhappy patient

Pars plana-assisted anterior segment reconstruction proves to be a more effective and safer approach for the visual rehabilitation of patients with anterior segment surgical complications, specially dislocated and opacified intraocular lenses.  Patients enjoyed improved or resolved symptoms after intervention. Emphasis should be placed on interdisciplinary collaboration, fluidics control in closed-system surgery, and safe adoption of basic vitreoretinal skills by anterior segment surgeons, as well as refractive considerations (modern IOL features, IOL formulas, etc.) for retina surgeons participating in complex anterior segment reconstruction

Pars plana intervention may be the best modality to address and improve anterior segment surgical challeges, especially dislocated or opacified IOLs