Three-dimensional telesurgery and remote proctoring over a 5G network
Purpose/UNASSIGNED:To present 2 cases of vitreoretinal surgery performed on a three-dimensional (3D) heads-up display surgical platform with real-time transfer of 3D video over a fifth-generation (5G) cellular network. Methods/UNASSIGNED:An epiretinal membrane peel and tractional retinal detachment repair performed at Massachusetts Eye and Ear in April 2019 were broadcast live to the Verizon 5G Lab in Cambridge, MA. Results/UNASSIGNED:Both surgeries were successful. The heads-up digital surgery platform, combined with a 5G network, allowed telesurgical transfer of high-quality 3D vitreoretinal surgery with minimal degradation. Average end-to-end latency was 250 ms, and average round-trip latency was 16 ms. Fine surgical details were observed remotely by a proctoring surgeon and trainee, with real-time communication via mobile phone. Conclusions/UNASSIGNED:This pilot study represents the first successful demonstration of vitreoretinal surgery transmitted over a 5G network. Telesurgery has the potential to enhance surgical education, provide intraoperative consultation and guidance from expert proctors, and improve patient outcomes, especially in remote and low-resource areas.
Neovascular complications associated with rubeosis iridis and peripheral retinal detachment after retinal detachment surgery [Case Report]
PURPOSE/OBJECTIVE:To report clinical features and surgical management of neovascular complications associated with rubeosis iridis and peripheral retinal detachment after retinal detachment surgery in nondiabetic patients. METHODS:Seven consecutive eyes of seven nondiabetic patients who developed neovascular complications associated with rubeosis iridis and peripheral retinal detachment after scleral buckling and vitrectomy procedures were retrospectively reviewed. None of the eyes had clinical evidence of anterior segment ischemia or retinal vascular disease, but each eye developed rubeosis iridis and neovascular complications. RESULTS:Of the seven eyes with rubeosis iridis and peripheral retinal detachment, six developed recurrent or progressive vitreous hemorrhage, and three developed progressive neovascular glaucoma. Four eyes underwent a revision procedure to repair the peripheral retinal detachment, and anterior proliferative vitreoretinopathy was found in each of these cases. Rubeosis iridis regressed in all three eyes in which surgery resulted in complete reattachment of the retina. In one eye with persistent peripheral retinal detachment and in the three remaining eyes that did not undergo revision surgery, rubeosis iridis persisted and was associated with long-term neovascular complications. Final corrected visual acuity was 20/70 to 20/400 in three eyes with total retinal reattachment and no light perception to hand motions in four eyes with persistent peripheral retinal detachment and rubeosis iridis. CONCLUSION/CONCLUSIONS:Visually significant neovascular complications may occur in eyes that develop rubeosis iridis associated with peripheral retinal detachment after retinal detachment surgery in nondiabetic patients. Successful repair of the peripheral retinal detachment may induce regression of rubeosis iridis, reduce associated complications, and improve the long-term prognosis of these eyes.
Circumpapillary chorioretinopathy in multiple evanescent white-dot syndrome [Case Report]
Detection of HIV-1 in surgical specimens from vitreous of AIDS patients [Letter]
Perfluorocarbon liquids in the management of traumatic retinal detachments
Low viscosity perfluorocarbon liquids were used as an intraoperative tool during vitrectomy for retinal detachment (RD) after penetrating ocular trauma. These liquids are immiscible with water and have specific gravities from 1.8 to 1.9. Intraoperatively, the perfluorocarbon liquids flattened the retina in 14 eyes by displacing the subretinal fluid through peripheral breaks. Posterior retinotomy was not required for internal drainage of subretinal fluid. Pooled subretinal fluid was displaced from the macular area in five patients. The perfluorocarbon bubble mechanically stabilized the retina during epiretinal membrane dissection. The perfluorocarbon liquid was removed and replaced perfluorocarbon gas or silicone oil. In 11 patients followed for more than 6 months after the final surgery, eight (73%) eyes were anatomically successful, with six (54.5%) gaining visual acuity of 20/400 or better.
Air travel with intraocular gas. I. The mechanisms for compensation
The absolute intraocular pressure of the gas-containing eye of a rabbit fell with the fall in cabin pressure during a simulated airplane ascent but lagged behind. The lag was manifested clinically as a relative rise in transscleral pressure. The amount of lag depended on the amount of gas in the eye at takeoff. As there is no significant transfer of gas out of the eye during the ascent, the fall in absolute intraocular pressure could only be mediated by expansion of the bubble. The enabling mechanisms for expansion are choroidal compression, scleral expansion, and accelerated aqueous outflow.
Transplanted retinal pigment epithelium modifies the retinal degeneration in the RCS rat
Transplantation of dissociated retinal epithelial cells obtained from the retinas of normal, congenic pigmented strain of rats to Bruch's membrane and the subretinal space of dystrophic rats from the Royal College of Surgeon (RCS) strain can prevent photoreceptor cell degeneration in this retina for at least 4 months after transplantation. Host and transplant cells form close apposition with one another but can be distinguished by the presence of both phagosomes and melanin granules in the transplant and the absence of these inclusions in the host retinal epithelium. Transplanted cells show excessive amounts of phagosomal material within 48 hr after transplantation, implying that restoration of phagocytosis is responsible for the photoreceptor survival.