Vitreo Retinal Surgery

Course Duration

6-12 Months course

Eligibility

Candidates should have passed Diplomate of National Board (DNB) Ophthalmology or MS/MD in Ophthalmology under recognized medical collages in India by Medical Council of India (MCI)

Basic Subjects

History taking relevant to Vitreo-retinal Diseases ,Methods of fundus examination Ultrasonography-theory, technique and interpretation ,Fundus Fluorescein Angiography – Theory, Technique and interpretation Electro diagnostic studies – Electro retinography, electro oculography and Visually evoked potentials-theory, technique and interpretation, Photocoagulation-Theory, and Principles Anatomy: Surgical anatomy of posterior segment (pars plana, vitreoretinal relationships, Ultra structure of retina and vitreous and other relevant anatomy, Physiology of posterior segment.

Medical Retinal Diseases

Vascular retinopathies:

• Diabetic Retinopathy
• Eales’ disease
• Sickle cell retinopathy
• Vascular occlusions
• Ocular Ischemic Syndrome
• Coat’s disease

Degenerative Diseases of Retina:

• Retinitis Pigmentosa and Variants
• Gyrate atrophy
• Choroideremia
• Retinoschisis and other retinal degenerative diseases

Retinal detachment and related disorders: (Clinical Diagnosis, differential diagnosis, predisposing factors, etiology):

• Rhegmatogenous retinal detachment
• Tractional retinal detachment
• Exudative retinal detachment

Congenital and childhood disorders:

• Persistent hyperplastic primary vitreous
• Retinopathy of prematurity
• Familial exudative vitreoretinopathy
• Norrie’s disease, congenital retinal dysplasias and other causes of congenital retinal detachments
• Colobomata of choroids and disc

Infective and related conditions:

• Endophthalmitis
• Toxocara retinochoroiditis
• Viral Retinitis
• AIDS and the eye
• Other parasitic diseases like cysticercosis, Gnathostomiasis etc

Oncology:

• Retinoblastoma
• Melanoma
• Cilinary body tumors
• Phacomatosis
• Optic nerve head tumors
• Miscellaneous – choroidal hemangioma, ocular lymphomas, secondaries, combined hamartoma, hemangloma of retina

Vitreous disorders:

• Hemorrhage
• Asteroid hyalosis
• Posterior Vitreous Detachment
• Vitreoretinal interface disorders like epiretinal membranes and macular holes

Anterior Segment disorders of Importance to Vitreoretinal surgeons

• Dislocated lens
• Dislocated IOL
• After Cataract and other pupillary membranes
• Irvine Gass syndrome and Vitreous wick syndrome
• Complicated Cataract
• Malignant Glaucoma

Macular disorders:

• Macular hole
• Dislocated IOLHeredomacular diseases
• Epimacular Proliferation
• Age related macular degeneration and other causes of Choroidal
• Neovascular Membrane
• Cystoid Macular Edema
• Macro Aneurysm
• Idiopathic Parafoveal Telangiectasia

Traumatic disorders:

• Globe rupture
• Double perforations
• Intraocular foreign body

Surgery for Vitreoretinal Diseases

Basic:

• Instrumentation for scleral buckling and vitreoretinal surgery
• Infusion fluids and buckle materials
• Vitreous substitutes – SF6, C3 F8, Silicone oil, perfluoro carbon liquid
• Techniques of scleral buckling – Implant, explant techniques
• Pneumatic retinopexy
• Basic vitreous surgery
• Membrane removal techniques
• Fluid air exchange
• Endolaser and endocryo
• Retinotomies and retinectomics

Surgical Management of Specific diseases:

• Giant retinal tear with RD
• Retinal detachment with Proliferative Vitreoretinopathy
• Complications of Proliferative diabetic retinopathy
• Macular hole
• Epimacular proliferation
• Submacular surgery
• Retinopathy of prematurity
• Retinoschisis
• Endophthalmitis
• Dislocated lens, nucleus, IOL
• Intraocular cysticercosis and other parasites
• Traumatic complications such as vitreous hemorrhage, dialysis, GRT and tractional and combined retinal detachment, IOFB.
• Combined penetrating Keratoplasty and Vitreoretinal surgery
• Miscellaneous – Ectatic scleral disorders, eye wall resection

Practical Exposure to the following techniques is required

Examination techniques:

• Direct Ophthalmoloscopy
• Indirect Ophthalmoscopy with scleral indentation
• Slit lamp biomicroscopy using +78 or +90d lens and contact lenses such as Goldmann, Mainster, Panfundoscopic lens
• Routine Ophthalmological examination techniques including slit lamp examination, applanation tonometry, Gonioscopy etc

Special Investigations:

• B-Scan Ultrasonography
• Fundus fluorescein angiography /indocyanine green angiography
• Indocyanine green angiography
• Optical coherence tomography
• Electro diagnostic studies
• Transillumination

OPD Procedures:

• Paracentesis
• Intra vitreal injection
• OPD fluid air exchange
• Laser Photocoagulation
• Trans conjunctival cryopexy
• Laser diopexy

Surgical procedures:

• Scleral buckling
• Pars plana Anterior segment procedures
• Pars plana vitreo retinal procedures for vitreous hemorrhage, Rhegmatogenous retinal detachment, TRD etc

Teaching Schedule

• Didactic lectures – twice a month
• Journal club – once a week
• Discussion on Fluorescein Angiogram/ICG/OCT – Once a week
• Discussion on Ultra sonogram – Once a week
• Case presentation – once a week

What is expected of the Fellow:

• Assist all varieties of Vitreoretinal surgeries
• Assist in the out patient department in the disposal of cases
• Take part in overall patient care
• Independently perform under supervision few scleral buckle, pars plana lensectomies, membranectomies, and simple vitrectomies.
• Perform independently photocoagulations both by slit lamps and indirect delivery method
• Aim to present at least one paper in any conference
• Maintain log book with all details as exemplified
• At least one research work leading to publication in peer reviewed journal.

Fellowship Application Form Vitreo Retina Surgery: Download Application Form