Most of the residents at my institution get very little experience with retina surgery, in comparison to anterior segment surgery. I assume retinal surgery is tougher because visualization is more difficult, but does it require more dexterity than, say, cataract surgery? Just wondering how people know they're cut out for retina (at least enough to apply for a VR fellowship) after only 2 years of ophtho residency, most of which is focused on anterior segment.
how much harder is retinal surgery than anterior segment surgery?
- Thread starter kwel
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Though the skill set is slightly different between anterior and posterior segment surgery, there is a lot of overalp. I wouldn't say posterior segment surgery is more difficult, just different in terms of procedures performed and skills required to perform them. With the proper training, any excellent anterior segment surgeon would be an excellent retina surgeon. In fact, in certain settings, retina surgeons still do a fair amount of anterior segment surgery and vice versa. After a few years of residency, you can figure out if you want to do retina or not. It's about the same amount of time you have to pick a specialty in medical school.
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Obviously individual anterior and posterior procedures are different but I am not sure to what specific "skill sets" you are all referring.
Retinal surgery training is limited in residency because vitrectomy is not part of the comprehensive ophthalmologist repertoire. Most are comfortable with medical retina including lasers, intravitreal injections, reading FAs/OCT.
The real question is if retinal pathology insterests you. You'll get plenty of retina exposure the first 2 years to know if you like it or not. The surgery skills comes with proper training.
It's more difficult for people wanting to do oculoplastics since it is an early match and the exposure is limited before you need to decide to beef up your CV.
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Use of the vitrector, 3 port placement, grid laser, buckles, membrane peels, pnemopexy. I think any good anterior segment surgeon would be a good posterior segment surgeon, but different procedures have their own learning curve. I think there is exposure to this in most residency programs, but a 2 year fellowship is where real hands-on training occurs.
Do most anterior segment surgeons become comfortable with the vitrector in cases of posterior capsular rupture w/ vitreous loss or cataract loss into the vitreous or is this usually referred out to VR?
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I no longer do anterior or posterior segment surgery, but I can say that vitreoretinal surgery is thought by many to be somewhat easier in one respect: the instruments are on a natural fulcrum--the eye wall. That makes controlling the instruments somewhat easier. The margin for error, when dealing with the retina, however, is much smaller, so it's arguably more difficult. It's all relative, though. Honestly, microsurgery is microsurgery. It's all tough, because you're operating with movements on the order of millimeters.
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Any cataract surgeon should feel comfortable doing limited anterior vitrectomy with the phaco machine in the setting of posterior capsular rupture. This can be done easily and effectively through the anterior segment. I have worked with a handful of very good anterior segment surgeons who felt comfortable doing this via a pars plana approach. This is only in the setting of almost no to minimal retained lens material.
However, with complete or even partial crystaline/nuclear lens loss into the vitreous, I would think most cataract docs would send that to VR doc. Have heard of crazy posterior levitation techniques to try to lift nuclear material out of the vitreous...not ideal.
Putting in lenses like sutured sulcus lenses and the like can be done by either.
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