International
Masters of Retina

Didier Ducournau:  At the 1994 Gonin Club meeting, I was called a criminal for removing the ILM in MH (After introducing the ILM peeling for ERM in 1985, I naturally applied the same technique to MH in 1990, before extending it to ME in 1996. These discoveries allowed me to understand the mechanism of ILM peeling: the retinal micro-trauma stimulates an innate response from the retina, resulting in Müller cell gliosis. These cells then become loaded with GFAP fibrils, whose effects on synaptogenesis are well-known. Didier will finish by showing his minilmally invasive technique,)

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Zofia Nawrocka : 10 year results of the inverted ILM Flap Technique (Zofia evaluates the 10-year anatomical and functional outcomes after vitrectomy with ILM flap technique for full-thickness MH and assess the incidence of long-term postoperative complications.

295 patients (323 eyes), operated from 2007 to 2014, 89 patients (99 eyes) completed a 10-year follow-up. The initial closure rate in 323 eyes was 93.5%; final closure rate after reoperation was 100%. 20/40 vision was achieved in 44.5% of eyes one year after surgery and in 70.7% of eyes followed until the 10th year. The number of eyes with >20/25 vision improved from 12% to 42.4% during that time. Patients achieving final BCVA better than 20/25 had a continuous IZ and EZ line until the hole margin before surgery (p=0.03), and a continuous IZ and EZ line one year after surgery (p=0.01). Foveal contour improved gradually over time. No MH reopenings were observed. Epiretinal gliosis developed in 7% of cases, associated with larger baseline hole size and preoperative ERM, but did not significantly impact final visual acuity. Retinal detachment incidence was 0.85% per patient/year.)

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Zofia Nawrocka :  Inverted flap technique in a patient after previous 2 spontaneous MH closures

Jerzy Nawrocki, Zofia Nawrocka : Unusual full thickness MH treated with ILM flap technique.

Andrei Drimbea: The French Macular Hole Study (Andrei presents a study of 538 MH operated on by french surgeons allowing to finally build guidelines according the type of PPV, the material used, the ILM peeling technique, the head positioning and the interest of the flap. This confirms that the more intraoperative manipulations are performed, the higher the complications risk will be)

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Don D'Amico: Current Decision Making in Macular Hole Surgery. (In this talk, Don will explore his current approaches to macular holes based on the latest clinical and his personal observations.  Beginning with the transformational work of Kelly and Wendel, followed by the addition of ILM peeling by Durcournau, Eckhardt, and others, and enhanced by the more recent ILM flap introduction by Zofia Navrocka and Jerzy Navrocki, there are now many choices for initial operation and reoperation of macular holes.  This increasingly complicated, and increasingly successful, decision tree will be discussed in an interactive format.)

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Hugo Quiroz-Mercado: Juvenile Retinal Detachment with Retinal Dialysis (We will discuss misdiagnosis, which may be common with OCT images, vitreous pigment, and chronic detachment. Management will be addressed as a key discussion point because pars plana vitrectomy is contraindicated.)

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Didier Ducournau & Alexandre Portmann:  90 minutes Review of RD Strategy (Retinal detachment treatment is increasingly shifting toward vitrectomy rather than buckling, with some surgeons now performing vitrectomies systematically. Didier analyzes the reasons behind this evolution, shaped by choices made over the last 50 years. An exhaustive review of the literature reveals that, in reality, the vast majority of detachments should not be treated by vitrectomy. A great topic for controversy !)

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Alexandre Portmann: Vitreo-Retinal Incarcerations (No rate of vitreoretinal incarceration following vitrectomy in humans is mentioned in the literature. Yet, it remains one of the key factors explaining vitrectomy failures. Alexandre analyzes the conditions and reasons for its occurrence, as well as the different therapeutic modalities)

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Andrei Drimbea: The French Retinal Detachment Study (The failure rate and final VA of more than 2300 RD - stage 0, A, B &C1 primary procedure - are analysed. Results confirm that we should not perform a systematic procedure)

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Nakul Singh: Semiology-driven strategy: learning curve for a US surgeon.

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Zofia Nawrocka : Rhegmatogenous retinal detachements with inferior causative tears (Vitrectomy for RD associated with inferior breaks carry an increased risk of surgical failure. Several surgical modifications, as 3600 laser, heavy silicone oils and adding a scleral buckle, were advised to overcome this problem. The long-ago abandoned traditional approach would be to place just a scleral buckle in those cases. However, literature on that topic is limited. Zofia presents a series of consecutive 30 patients treated with scleral buckling only, which was associated with high single- surgery success rate.

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Don D'Amico: How Relaxing Retinotomy Got An Undeserved Bad Name. (Relaxing retinotomy is usually relegated to the very last place in surgical maneuvers to achieve retinal reattachment.  But is this really fair to the power and potential of this technique?  Don will review his own much-more-liberal use of retinotomy for PVR and other forms of retinal detachment, and also cite the turning point in the literature in which Etienne Bovey of Lausanne demonstrated that retinotomy is not the evil, last ditch maneuver that many retinal surgeons consider it to be.  Again, this will be presented in a setting for lively discussion.)

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Keith Warren: Flow control 2.0

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Didier Ducournau: How to set up your vitrectomy machine (Since almost all the platforms are now equipped with an aspiration flow control, Didier will explain how to select the settings that will allow you to achieve a faster, more complete, and safer vitrectomy.)

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Alexandre Portmann : Classic cutting or double cutting system?

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Alexandre Portmann:  The Power of the Microscope

Alexandre Portmann: Why did I fail ? (a clinical case)

Armando Sandoval: Early Onset Drusen Appearance in people younger than 50 years (Prophylaxis is better than stablished treatments)

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Zofia Nawrocka :  Iatrogenic full thicknes macular hole after surgery for epiretinal membrane

Didier Ducournau:  Is Macular Hole an Ischemic Disease? (MH is not induced by PH contraction since it can appear in cases where PH and even ILM have been removed. Didier is going to explain why choroidal ischemia can be the initiating process at the origin of a MH, as well as equatorial tears leading to RD)

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Pierre Olivier Lafontaine & Alain Mayeras: Vortex Vein Occlusion: A Novel Hemodynamically Guided Surgical Approach for Non-Neovascular AMD (Vortex Vein Occlusion (VVO) is an original surgical technique designed to modulate choroidal venous drainage in patients with non-neovascular AMD from early and intermediate stages to established atrophic disease. This presentation will introduce the anatomical and physiological rationale underlying the development of the technique and discuss the hemodynamic mechanisms that may contribute to its effects on choroidal perfusion. Particular emphasis will be placed on blood-flow redistribution, functional recruitment of previously hypoperfused choriocapillaris, and changes in choroidal vascular volume. A retrospective quantitative OCT analysis of approximately 100 operated patients is currently underway to assess postoperative changes in choroidal thickness and, subsequently, three-dimensional choroidal volume. These imaging biomarkers have recently been associated with AMD progression and may provide new insights into the physiological effects of VVO.)

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Calvin Mein: A  Case of Myopic Macular Schisis

Calvin Mein: A Mystery Case

Calvin Mein: Another Mystery Case

Armando Sandoval: 20 years lasting macular edema after RVO