Surgical ingenuity highlighted at 2017 EURETINA Video Awards

Subhendu Kumar Boral of India and and Laura Sararols Ramsay, joint first prize winners in the 2017 EURETINA Video Awards Competition pictured with Sebastian Wolf Rescue strategies in difficult surgical situations and the intricate detail of posterior hyaloid dissection were among some of the vitreoretinal surgical techniques showcased in the 2017 EURETINA Video Awards, with the very high standard of entries this year praised by Sebastian Wolf, incoming President of EURETINA. First prize this year was shared jointly by Subhendu Kumar Boral of India, for his entry on "Innovative approaches to dealing with difficult retained intraocular foreign bodies", and Laura Sararols Ramsay of Spain, for her video entitled “Posterior Hyaloid Dissection: Let’s make it easy with blue”. This year’s second prize was also awarded jointly to Konstantinos Anastasilakis of Greece, for “Tips, tricks and advantages of 27-gauge vitrectomy”, and Maria Isabel Relimpio López of Spain, for “Extreme Surgical Manoeuvres in Fungal Endophthalmitis”. Third prize went to Osman Mohammed of Qatar, for “Sutureless pars plana vitrectomy for intraocular foreign body”. Dr Boral’s prize-winning video entry presented two delicate situations that required the surgeon to apply “skill, imagination and innovative application” to successfully remove a foreign body. The first example was a post-trauma case of a repaired cornea in an aphakic patient, with a vitreous haemorrhage and a large foreign body of 6mm in length and 3mm in width trapped in the sclera and the inferior macula. Successfully removed Vitrectomy was performed followed by several unsuccessful attempts to remove the foreign body using a bent 24-gauge needle and a 20-gauge holding forceps and magnet. With few options left, the surgeon then had the idea to try multiple radial-releasing incisions in the sclera using a 23-gauge blade. The fragment was then bimanually manipulated with a bent-tip 24-gauge needle and magnet, and perfluorocarbon liquids were injected to protect the macula. The foreign body was then successfully removed through the limbal section. The second case was even more unique and challenging, involving a large nail 20mm long that was embedded in the superior sclera with partial localised retinal detachment. After vitrectomy and removal of all adhesions surrounding the foreign body, an intravitreal serrated forceps was used to disengage the foreign body from the sclera. The bulbous portion of the nail made removal impossible through the scleral port using a magnet. To resolve the problem, Dr Boral used a nylon suture noose to tie to the nail and successfully pull it through the scleral port. Surgical strategies to make posterior hyaloid dissection simpler were highlighted by Dr Sararols Ramsay in her video. Her video presented a new surgical technique using blue dye, which allows the surgeon to easily visualise the posterior hyaloid, differentiating when it is adhered or not to the posterior pole. The dye is the same as that used for epiretinal macular membrane (ERM) dissection or internal limiting membrane (ILM) dissection. The technique does not add any additional steps to regular surgery, with the dye injected over the posterior pole just after core vitrectomy. The dye adopts what Dr Saralols Ramsay called a “blue lagoon” form, i.e shaped like a lake, if the hyaloid is not adhered, and “blue bulks” if it is adhered to the posterior pole. With the vitrector tip the surgeon can then aspirate and “grasp” the posterior stained hyaloid and easily see how the blue dye moves and cleaves between the layers. Using the blue stain immediately after the central vitrectomy allows a perfect visualisation of the situation of the posterior hyaloid, and its dissection can be performed in an easy and secure way, she concluded.