Media Type: Textbook

Synopsis: Over the last three decades, retina and vitreous microsurgery has evolved with many significant improvements in technique and instrumentation. Dr Steve Charles, who has been a leading innovator and developer of these, has distilled his techniques into the latest, the fifth edition of Vitreous Microsurgery .

The book is divided into sections dealing with surgical technology, instrumentation and basic techniques. The basic technique Chapter 6 is an absolute gem.

The latter part offers more detailed, up-to-date chapters on specific entities. The new book is superbly illustrated with 3-D drawings depicting the described methodology. The only criticism is directed to the methods described being one surgeon’s way of doing things.

This textbook is a valuable reference resource for all retina surgeons and a must-read for those in training or fresh into their surgical careers.

Target Audience: Vitreoretinal surgeons and students of vitreoretinal surgery.

Review: Dr Steve Charles has been an innovator, developer and teacher in the field of vireo-retinal surgery over the last three decades. As a fan of his first edition of Vitreous Micro Surgery , I have thoroughly enjoyed the latest, full-color, and beautifully-illustrated fifth iteration.

The book is divided into four broad sections: Section one is pre-surgical evaluation, which provides a nice overview of patient selection.

Section two is a wealth of information dealing with instrumentation and the physics of vitrectomy instruments. Any new retina trainee will find this a great resource of understanding ‘how things work’ inside the eye. The basic technique chapter is absolutely essential to understand tissue dynamics and how surgical manipulation works. I recommend that this chapter be a must-read for all surgeons.

As a retina surgeon who has used all current and past vitrectomy machines, the chapter on “Cutters” is excellent on the evolution of what I believe is the best instrument available at the present time (This is a design that Dr Charles has been instrumental in developing). The chapters on 20, 23, and 25 G vitrectomy, though slightly repetitious, are adequate.

Section three is a brief on in-office procedures like laser and pneumatic retinopexy.

Section four deals with specific conditions like macular holes, primary retinal detachments, diabetic retinopathy, sub-macular surgery, and traction retinal detachments with ROP. These are all described in more detail, building on the basic techniques at the beginning of the book. The illustrations with large full-color, 3-D images are appropriate for the techniques described in the text.

There are pearls of surgical brilliance: using air to fashion a relaxing retinotomy in PVR, making an arcuate incision temporal to the macula for large, chronic macular holes and a detailed discussion on ‘inside out’ dissection technique that the author has advocated for years. The section on diabetic traction detachments is detailed in the different approaches necessary for a complex problem.

Similarly, the concepts of the physics of gas, viscoelastics and silicone oil are scattered throughout the book and should make for ‘got-it’ moment for those who didn’t.

There are a few criticisms: As with any single author textbook, these techniques described are biased towards one way of doing things. For example, in Chapter 13 the authors state that they never do scleral buckle when doing a vitrectomy (though the brief section on scleral buckles is nicely done). Most mainstream retina surgeons will still add a scleral buckle to eyes with PVR. Similarly, using perfluro octane or silicone oil in cases where there is fogging of the IOL (Chapter 14) is uncommon since the same result can be obtained with the use of a viscoelastic, avoiding a second, later surgery. Most retina surgeons loathe leaving per fluoro octane in the eye for a period of several days due to associated retinal ischemia or fibrous proliferation with silicone oil.

The text and illustrations go well together and the ‘lay-out’ makes it an easy-read. This is a book that should belong in every retina surgeon’s library for ready reference and should be required reading for retina fellows in training. I recommend it highly.