The future of vitrectomy

Abstract

Entering into its fifth decade, vitrectomy continues to be an effective and safe solution for a myriad of vitreoretinal diseases. As knowledge about vitreous and the vitreoretinal interface continues to expand, vitrectomy technology and techniques have responsively evolved. The most recent innovations have included refinements of vitreous cutter and aspiration systems, improvements in illumination source and light delivery devices, and enhancements to intraoperative visualization systems. More excitingly, there are several emerging developments on the horizon, including the integration of augmented reality technology, robotic vitreoretinal surgery, gene and stem cell-based therapies, retinal prostheses, and novel drug delivery methods. This fantastic process of evolution continues to improve the safety and efficacy of vitrectomy, as well as expand its indications. As surgical outcomes continue to improve and complications are mitigated, new indications for vitrectomy have developed. Minimal vitrectomy that involves removal of floaters or early preretinal membranes along with the posterior vitreous cortex and sparing the anterior vitreous may become the standard of care for certain indications, thereby reducing post-vitrectomy cataract development [see chapter V.B.8. Floaters and vision – current concepts and management paradigms]. With advanced imaging, such as spectral-domain OCT, we have identified new pathologies like vitreo-macular adhesion, which has been shown to play a role in diabetic retinopathy (DR) and exudative AMD. “Preventive surgery” for AMD and DR may become acceptable to arrest disease process early on. Such preemptive surgery may help to reduce blinding complications in their advanced stages. Application of pharmacologic vitreolysis before pars plana vitrectomy will encourage even more liberal use of vitrectomy for such “new indications” [see chapter VI.A. Pharmacologic vitreolysis].