Eyeworld

115 EW RETINA September 2016 2. Brazitikos P. Scleral buckling versus primary vitrectomy. Ophthalmology. 2006;113:1245. must be taken to not remove any PFO. The 25-gauge dual-bore VFI (MedOne Surgical, Sarasota, Florida) is ideal to inject PFO while allowing infusion fluid egress to maintain appropriate IOP. 25-gauge sutureless vitrectomy I use a 25-gauge sutureless approach for all vitrectomies including rheg- matogenous retinal detachments, PVR, giant breaks, and diabetic traction retinal detachments. Just as today's patients expect emmetropia without strabismus or ptosis as dis- cussed above, they expect a painless procedure and a non-inflamed eye. A non-inflamed, pain-free eye is not achievable with 20-gauge sutured wounds or vit-buckles. Contrary to what some surgeons think, 25-gauge vitrectomy fluidics are preferable to 23-gauge or 20-gauge fluidics for RD cases because port-based flow limiting due to a smaller lumen reduces pulsatile vitreoretinal traction. I strongly recommend use of the highest possible cutting rate for all tasks and all cases, especially for giant breaks and other retinal detachment cases. I use only the Constellation Vision System (Al- con, Fort Worth, Texas) currently with 7,500 cuts/minute, soon to be 10,000 cuts/minute. Sutured-on contact lenses damage the conjunc- tiva, cause subconjunctival bleeding, and are inappropriate for sutureless, transconjunctival surgery. Summary Sutureless, transconjunctival mi- croincisional vitrectomy is ideal for retinal detachment repair. In my opinion, vit-buckles are no longer indicated; the focus should be on microincisional vitrectomy tech- niques and wide-angle visualiza- tion to repair retinal detachments without causing pain, refractive error, strabismus, ptosis, cosmetic problems, and longer, more costly operating times. EW References 1. Smiddy WE, et al. Refractive changes after scleral buckling surgery. Arch Ophthalmol. 1989;107:1469–71. Editors' note: Dr. Charles is in practice at Charles Retina Institute, German- town, Tennessee. He has financial interests with Alcon. Contact information Charles: scharles@att.net 2015 ASOA EHR Satisfaction Survey Results* 1. EyeMD EMR scored higher on Overall System Functionality than any other vendor. 2. EyeMD EMR users report experiencing less hidden costs than any other vendor. 3. Users are more likely to recommend EyeMD EMR than any other vendor. *Based on recent customer satisfaction survey conducted on behalf of the ASOA. ASOA survey results represent opinion only, and are not in any way intended for use as a ranking tool. A COMPLETE EMR WITH NO HIDDEN COSTS? Yes, it's true! EyeMD Electronic Medical Records is your complete EMR solution. Designed specifically for ophthalmologists, it gives you all of the features and functionality you need 1 , with no hidden costs 2 . Every installation includes built-in DICOM imaging, server monitoring, diagnostic machine integrations, and no-cost seamless integration with more than 80 practice management systems. We are consistently rated very high in customer satisfaction and response and, according to the 2015 ASOA EHR survey, our customers are more likely to recommend our product than any other vendor 3 . Choose EyeMD EMR. The full-featured EMR/EHR solution for ophthalmologists. Call 1-877-2-EYE-EMR to schedule your free demo today! www.EyeMDEMR.com | (877) 2 EYE EMR to schedule your free demo today! ON E O F T H E F AS TES T GRO W I N G P R I VA TE CO M P A N I ES I N T H E U SA T H R EE YEAR S I N A RO W ! C M Y CM MY CY CMY K

• Cover