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Indian Journal of Ophthalmology logoLink to Indian Journal of Ophthalmology
. 2025 Sep 19;73(11):1658–1665. doi: 10.4103/IJO.IJO_926_25

Management of retinal detachment and myopia – practice patterns among vitreoretinal surgeons of India – A VRSI survey

Manavi D Sindal 1,✉,#, Akshat Kothari 1,#, Priyanka Mahendrakar 1, Divyansh Mishra 1, Mudit Tyagi 2, Mihir Vaidya 1, Shivraj Tagare 1, P Mahesh Shanmugam 1
PMCID: PMC12659842  PMID: 40977429

Abstract

Purpose:

To present results from the Vitreo Retina Society-India (VRSI) 2024 Preference and Trends (PAT) survey focusing on retinal detachment (RD) and myopia management practices among Indian vitreoretinal surgeons.

Methods:

A 62-item questionnaire was distributed to all VRSI members over email. Responses were collected over 6 weeks by google forms. Data were analyzed using descriptive statistics.

Results:

A total of 289 members participated in the survey. Prophylactic barrage prerefractive surgery was preferred by 55.21% of the respondents. For phakic retinal detachments, scleral buckling was preferred in the absence of posterior vitreous detachment (PVD) (69.45% single hole, 52% multiple holes), while in pseudophakic, the trend was toward vitrectomy, with an encirclage for inferior breaks (54.38% with no PVD, 52.75% with PVD). For RD with superior breaks with < Grade B PVR, respondents preferred laser to break alone intraoperatively during vitrectomy (65.44%) compared to 360-degree laser and gas tamponade (67.52%), while silicon oil was more preferred tamponade for RD with inferior breaks with > Grade B PVR (99%). Respondents preferred imaging myopic choroidal neovascular membranes with optical coherence tomography and optical coherence tomography angiography (45.42%), initiate treatment with ranibizumab (41.2%), and follow pro-re-nata regimen (61.62%). For myopic macular schisis, vitrectomy was the preferred management for Stage 2C (70%) and Stages 4A and 4C (80%).

Conclusions:

The VRSI-PAT survey highlights current diverse preferences among Indian vitreoretinal surgeons. These survey results will guide fellow practitioners to understand current real-world practice with relation to established literature.

Keywords: Myopia, myopic choroidal neovascular membrane, myopic tractional maculopathy, Preferences and Trends (PAT), retinal detachment, survey, Vitreo Retina Society-India

The field of vitreoretina is constantly evolving with advances in imaging, available interventions, newer intravitreal agents, and refined surgical instrumentation. Robust evidence is available from published literature in the form of randomized controlled trials, various case-control or cohort studies, and even case reports. Translation of the available evidence from the literature to real world is influenced by many factors, and understanding how health care is delivered at the ground level can help formulate further policies as well as recommendations.

The Preferences and Trends (PAT) survey is a well-established initiative conducted by the American Society of Retina Specialists (ASRS) to gather insights into the practice patterns of retina specialists world over.[1] Conducted annually since 1999, it serves as a valuable resource to the practicing vitreoretinal surgeon by providing an insight into real-world implementation of evidence available for clinical trials. Recognizing the importance of such data in shaping real-world practices, the Vitreo Retina Society-India (VRSI) conducted a similar survey among its members in April 2020,[2,3] offering an opportunity to assess preferences and trends specific to the Indian context. With significant differences in access to care, economic constraints, and patient demographics, an India-focused survey is essential to understand how practitioners adapt their practices to patient care. With this perspective in mind, VRSI conducted another PAT survey among its members in July–August 2024.

Retinal detachment (RD) is a sight-threatening condition that requires timely diagnosis and prompt intervention. While traditional techniques like scleral buckling (SB) remain effective in select cases, advances in pars plana vitrectomy (PPV) have led to a shift in surgical preferences. Myopia, particularly pathological myopia, is associated with significant complications like myopic choroidal neovascular membrane (CNVM) and myopic traction maculopathy (MTM). We present the PAT for management of RD and myopia-related complications in this report.

Methods

A questionnaire based on current PAT, pertaining to imaging and management in 1. Retinal detachment, 2. Myopia, 3. Polypoidal choroidal vasculopathy, and 4. Diabetic retinopathy, was prepared by five qualified vitreoretinal (VR) surgeons (Author 1, Author 2, Author 3, Author 6, Author 7) and revised by two other VR surgeons (Author 4, Author 8). The questionnaire [Supplemental Appendix 1] was shared via a google form with members of VRSI through e-mails in July–August 2024 over a period of 6 weeks, requesting recipients responses. Ethical clearance was not required for the survey.

The survey was delivered to all 1729 VRSI members, out of which 289 (16.71%) members responded. The survey featured 62 questions, each presenting 4–5 response options. Participants were allowed to select only one response per question. The survey was conducted independently, without third-party sponsorship, and no incentives or rewards were offered for participation. The staging and classification system of MTM was shared along with the questionnaire.[4] Descriptive statistics and frequency tables are used to summarize the results, and the nominal data were analyzed with Microsoft Excel (Richmond, USA).

In this article, we present results on the RD and myopia subsections.

Results

Demographics

A total of 289 (16.71%) members of VRSI responded to the questionnaire. The age of the respondents ranged from 29 to 75 years with a mean of 42.9 (+9.6) years, of whom 69.1% were males and 30.9% females. The majority (93.7%) practiced in urban areas. The majority of the respondents were associated with an institutional hospital (40.14%), followed by a private individual hospital (36.33%). A majority of respondents (94.12%) had formal training in surgical vitreo retina. The participants had a mean experience of 12.43 (+9.36) years in vitreoretina practice [Appendix 2, Table 1].

Retinal detachment

Prophylaxis

Regarding prophylactic barrage prerefractive surgery, 159 (55.21%) respondents routinely perform barrage laser treatment on all retinal lattices, while 56 (19.44%) restricted barrage to lattices with atrophic holes and visible traction. For retinal breaks with subretinal fluid (SRF) (defined as a single break with up to 1 disc diameter (DD) of fluid limited anterior to the equator), 262 (90.66%) of respondents preferred barrage laser the breaks and fluid. In cases of subclinical RD (defined as a break with SRF greater than 2 DD limited anterior to the equator), preferences were divided, with 131 (45.96%) favoring laser demarcation along the margin of the detachment and 121 (42.46%) opting for pneumatic retinopexy or scleral buckling procedures [Appendix 2; Table 2].

Surgical management of RD

The preferences and trends in the surgical management of RD in phakic eyes with and without posterior vitreous detachment (PVD) across various clinical scenarios are presented in Table 1. For RD in phakic eyes, SB was the predominant choice for 191 (69.45%) respondents in the presence of single hole with no PVD, 151 (54.12%) for single hole with PVD, or 143 (52%) for multiple holes with no PVD. PPV was favored by 127 (45.68%) when PVD was present with multiple holes. In retinal detachments associated with proliferative vitreoretinopathy (PVR), PPV was the preferred approach for superior detachments, regardless of PVD status. For inferior detachments, there was a notable shift toward combining vitrectomy with encirclage.

Table 1.

Preference and trends related to surgical management of retinal detachment in phakic eyes without and with posterior vitreous detachment

PPV n (%) Pneumatic retinopexy n (%) Scleral buckling n (%) Vitrectomy with encirclage n (%) P C
Retinal Detachment in Phakic eyes Without Posterior Vitreous Detachment
    Single hole 28 (10.18) 51 (18.55) 191 (69.45) 5 (1.82) <0.001
    Multiple holes 90 (32.73) 5 (1.82) 143 (52.00) 37 (13.45) <0.001
    PVR grade B superior 120 (43.80) 4 (1.46) 95 (34.67) 55 (20.07) <0.001
    PVR grade C superior 150 (54.55) 1 (0.36) 13 (4.73) 111 (40.36) <0.001
    PVR grade B Inferior 96 (35.16) 1 (0.37) 53 (19.41) 123 (45.05) <0.001
    PVR grade C Inferior 101 (37.00) 0 9 (3.30) 163 (59.71) <0.001
Retinal Detachment in Phakic eyes With Posterior Vitreous Detachment
    Single hole 58 (20.79) 66 (23.66) 151 (54.12) 4 (1.43) <0.001
    Multiple hole 127 (45.68) 6 (2.16) 88 (31.65) 57 (20.50) <0.001
    PVR grade B superior 149 (53.41) 4 (1.43) 68 (24.37) 58 (20.79) <0.001
    PVR grade C superior 168 (60.43) 0 4 (1.44) 106 (38.13) <0.001
    PVR grade B Inferior 113 (40.79) 1 (0.36) 38 (13.72) 125 (45.13) <0.001
    PVR grade C Inferior 106 (38.27) 0 4 (1.44) 167 (60.29) <0.001
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Bold indicates most preferred response among the options. C – Chi-square test. PVD - posterior vitreous detachment, PVR - proliferative vitreoretinopathy, RD - Retinal detachment

The PAT in the surgical management of RD in pseudophakic eyes with and without PVD across various clinical scenarios are presented in Table 2. PPV was the dominant choice in most scenarios, especially for cases involving multiple retinal holes or PVR. Vitrectomy combined with encirclage was preferred over PPV alone in inferior detachments with PVR exceeding grade C. SB played a diminished role compared to its usage in phakic eyes (in eyes where no PVD was preferred by 94 (34.31%) respondents), while pneumatic retinopexy was rarely employed, even for simpler detachments.

Table 2.

Preference and trends related to surgical management of retinal detachment in pseudophakic eyes without and with posterior vitreous detachment

PPV n (%) Pneumatic retinopexy n (%) Scleral buckling n (%) Vitrectomy with encirclage n (%) P C
Retinal Detachment in Pseudophakic eyes Without Posterior Vitreous Detachment
    Single hole 128 (46.72) 39 (14.23) 94 (34.31) 13 (4.74) <0.001
    Multiple holes 185 (67.77) 4 (1.47) 41 (15.02) 43 (15.75) <0.001
    PVR grade B superior 190 (69.34) 2 (0.73) 25 (9.12) 57 (20.80) <0.001
    PVR grade C superior 170 (62.04) 1 (0.36) 3 (1.09) 100 (36.50) <0.001
    PVR grade B Inferior 136 (49.64) 1 (0.36) 18 (6.57) 119 (43.43) <0.001
    PVR grade C Inferior 124 (45.26) 0 1 (0.36) 149 (54.38) <0.001
Retinal Detachment in Pseudophakic eyes With Posterior Vitreous Detachment
    Single hole 166 (61.25) 48 (17.71) 47 (17.34) 10 (3.69) <0.001
    Multiple hole 209 (76.28) 4 (1.46) 20 (7.30) 41 (14.96) <0.001
    PVR grade B superior 209 (76.28) 2 (0.73) 14 (5.11) 49 (17.88) <0.001
    PVR grade C superior 184 (66.91) 1 (0.36) 2 (0.73) 88 (32.00) <0.001
    PVR grade B Inferior 153 (56.04) 0 10 (3.66) 110 (40.29) <0.001
    PVR grade C Inferior 128 (46.89) 0 1 (0.37) 144 (52.75) <0.001
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Bold indicates most preferred response among the options. C – Chi-square test. PVD, posterior vitreous detachment; PVR, proliferative vitreoretinopathy; RD, Retinal detachment

The trend for laser retinopexy intraoperatively was a preference for lasering only the break (178 (65.44%)) in case of superior lesions with early or no PVR, whereas for inferior breaks with early or no PVR, the preference was divided with 125 (45.96) preferring to laser the break alone versus 147 (54.04) opting for 360-degree laser retinopexy. In cases with PVR more than grade C, for superior breaks (200 (74.07%)) and inferior breaks, 211 (77.86%) preferred 360-degree laser retinopexy [Fig. 1;8, 1;9].

Figure 1.

Figure 1

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Preference and trends survey results related to choice of laser retinopexy and tamponade in various scenarios of retinal detachment. PVR- Proliferative Vitreo-retinopathy, Data labels presented as n (%). Numbering as per questionnaire in Appendix 1

Gas tamponade was favored for RD with superior breaks and PVR less than grade B (185 (67.52%)), while silicon oil was the choice of tamponade for superior breaks with PVR more than grade B (215 (78.47%) and inferior breaks irrespective of grade of PVR (PVR Grade B or less 210 (76.64%) and PVR Grade C or more 202 (73.19%)) [Fig. 1;10, 1;11].

Myopia

Myopic choroidal neovascular membrane (CNVM)

For diagnosis and follow-up in patients with myopic CNVM, 129 (45.42%) of respondents preferred imaging by optical coherence tomography (OCT) with OCT angiography (OCTA), followed by OCT alone by 79 (27.82%) [Fig. 2; 12]. For initiating treatment for myopic CNVM, the majority of respondents (117 (41.20%)) preferred Ranibizumab, followed by Ranibizumab biosimilars (84 (29.58%)) as the first line injectable anti-vascular endothelial growth factor (VEGF) [Fig. 2; 13], with a majority of 175 (61.62%) preferring the pro re nata (PRN) regimen from the initiation of treatment [Fig. 2;14]. In a patient previously treated with a loading dose of anti-VEGF and stable for 6 months, the majority of respondents (235 (83.63%)) would reinitiate treatment if new hemorrhage was observed clinically [Fig. 2; 15].

Figure 2.

Figure 2

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Preference and trends survey data related to investigations and management of myopic choroidal neovascularization. CNVM- Choroidal Neovascular membrane, OCT-Optical Coherence topography, FFA- Fundus Fluorescein Angiography, OCTA-Optical Coherence Topography-Angiography, PRN- Pro-Re-Nata, T and E- Treat and Extend, SHRM- Subretinal Hyper-reflective membrane. Data labels presented as n; % Numbering as per questionnaire in Appendix 1

Myopic macular schisis and complications

When imaging to detect myopic macular schisis, the majority of the respondents (159 (56.58%)) preferred utilizing a combination of horizontal and vertical raster scans, radial scans, and macular cube scans for OCT imaging, rather than relying on a single OCT protocol [Appendix 2; Table 3].

For management of myopic macular schisis, the majority (259 (95.22%)) of respondents preferred observation with regular follow-up for cases involving only inner and outer schisis (Stages 1A and 2), monitoring for vision decline or worsening metamorphopsia [Fig. 3;17]. PPV was the preferred management by 187 (70%) of respondents for outer schisis with a macular hole (Stage 2C) and by 208 (80%) respondents for macular detachment with or without a macular hole (Stages 4A and 4C) [Fig. 3;18, 3;19, 3:20]. Macular buckling, in combination with PPV, was preferred at a slightly higher rate (49 (18.85%)) for Stage 4C cases involving a macular hole [Fig. 3;20]. In symptomatic foveoschisis, PPV with fovea-sparing internal limiting membrane (ILM) peeling was the preferred approach for 151 (57.20%) of respondents [Fig. 3;21]. Additionally, PPV with ILM peeling was selected by 221 (85%) of respondents for RD associated with a macular hole secondary to myopic traction maculopathy [Fig. 3;22].

Figure 3.

Figure 3

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Preference and trends survey data pertaining to surgical considerations in myopic traction maculopathy. PPV- Pars plana vitrectomy, ILM- Internal limiting membrane. Data labels presented as n; % Numbering as per questionnaire in Appendix 1

The preference for using perfluorocarbon liquid (PFCL) for ILM peeling in macular hole RD was divided with 152 (56.3%) of participants preferring its usage, while 118 (43.7%) did not. In recurrent MH-RD secondary to myopic tractional maculopathy, 177 (70%) of respondents preferred revitrectomy combined with a free-flap technique, while only 59 (23%) tended to use a retinal autograft. Instrumentation preferences for vitreoretinal procedures in high myopia were nearly evenly divided, with 151 (56%) favoring the 25-gauge vitrectomy system and 113 (42%) choosing the 23-gauge system. Nonexpansile gas was the tamponade of choice for 195 (73%) of participants when treating myopic macular hole [Appendix 1; 26]. In MH-RD cases with an axial length exceeding 30 mm and where ILM peeling is not feasible, the majority did not opt for barrage laser around the macular hole (196 (73.68%)) [Appendix 2; Table 3].

Discussion

In this VRSI-PAT 2024 survey, PAT for managing cases with RD and myopia with its associated complications are presented. In certain areas, distinct preferences for similar techniques were noted, while in a few, the preferences were divided. The preferences with the corresponding current literature on the subject are discussed here.

Prophylactic barrage prior to refractive surgery has been a subject of much debate. In the VRSI-PAT 2024 survey, more than half the respondents preferred to routinely barrage all lesions. The guidelines for prophylaxis prior to refractive surgery recommend prompt barrage for all symptomatic and asymptomatic breaks, but asymptomatic lattices and atrophic holes can be observed.[5,6]

For asymptomatic subclinical RD, treatment in the form of SB,[7] pneumatic retinopexy,[8] and laser demarcation[9] are described in the literature. Subclinical RD, especially inferiorly, may slowly progress to clinical RD, remaining asymptomatic until they threaten the macula.[10] In this VRSI-PAT 2024 survey, the preference for subclinical RD management was divided between barrage laser and surgical intervention. While there are no well-defined guidelines for the management of subclinical RDs, a survey in the UK revealed varied opinions in various scenarios ranging from observation in presence of a demarcation line to laser barrage for small break with surrounding SRF to surgical intervention, especially if demarcation line was not seen.[11]

For surgical management of RD, scleral buckling is a time-tested surgical modality, with more and more surgeons preferring vitrectomy for managing rhegmatogenous RDs. In the VRSI-PAT 2024 survey, SB was preferred in phakic eyes without a preexisting PVD in the presence of single or multiple breaks, and for single breaks with PVD. An anatomical success rate of 91% in phakic eyes without PVD has been reported by Noori et al.,[12] making SB a viable option for young patients.

For eyes with inferior breaks, the respondents in the VRSI-PAT 2024 survey showed a trend toward using an encircling element in phakic eyes with inferior breaks, irrespective of PVD and PVR status. In pseudophakic eyes, the trend was seen in eyes with more PVR and inferior breaks. PRO study report 9[13] indicated that the single surgery success for combining a buckling element with PPV is higher than PPV only in case of Phakic RD compared to pseudophakic RD as thorough anterior vitrectomy is sometimes not possible in phakic and leaving vitreous behind may fail to relieve anterior traction on the breaks, while Lena et al.[14] in their systemic review did not find any additional benefit of adding encirclage. Encircling elements can support the vitreous base, relieve traction, and appose retina to the pigment epithelium, offsetting the reduced tamponading effect inferiorly, especially of silicon oil. SB and vitrectomy with SB have a higher single surgery success rate in phakic moderately complex RDs.[15]

In the VRSI-PAT 2024 survey, a trend toward PPV for pseudophakic RDs was noted, with encirclage being preferred only in cases with an inferior break with PVR, which is similar to the preference seen in the ASRS-PAT survey.[1] A single surgery anatomical success rate of 84% for PPV and 92% for PPV with buckle was reported by the PRO study group, indicating use of an encirclage may be beneficial.[16] Pneumatic retinopexy, though widely reported in the literature, was an option in superior single breaks for a minority of respondents in the VRSI-PAT 2024 survey. The success rate for pneumatic retinopexy is reported to be only 59.82%[17] and is indicated for uncomplicated superior phakic RD having better single operation success compared to pseudophakic RD.[18]

In the VRSI-PAT 2024 survey, localized laser to break alone was preferred for superior breaks with no PVR, while the trend was toward 360 barrage for inferior breaks or in cases with PVR more than Grade C. Various studies[19,20] have shown no difference in retinal reattachment rate with either localized laser photocoagulation or 360 degree laser. Wang et al.[20] in their report showed that 360 laser use was associated with younger patient age, multiple breaks, larger extent of RD, and surgeon preference. They also found the final anatomical success was lower in those who received 360 laser, possibly as these cases had more breaks or advanced PVR, whereas Zhou et al.[21] in their study found higher single surgical attachment rate in eyes which had undergone 360 degree laser compared to localized laser.

Tamponade agents are used to provide surface tension across retinal breaks preventing fluid flow into the subretinal space until chorioretinal adhesion forms from the retinopexy.[22] Nonexpansile gas (20% SF6 and 14% C3F8) and silicon oil (1000 cst and 5000 cst) are the commonly preferred tamponading agents following RD surgery. In the VRSI-PAT 2024 survey, two-thirds of respondents preferred using gas in RD with superior breaks with no PVR, while the trend was toward silicon oil in all other scenarios, with 5000cs oil preferred with increasing PVR and inferior breaks. Both oil and gas tamponades have comparable primary attachment rates, but functional outcomes are better with gas tamponade.[23] However, Quiram et al.[24] found silicon oil tamponade to be superior to gas in eyes with recurrent RD with PVR, while Scott et al.[25] reported that in complex RDs, there was no difference in anatomical or visual outcomes between 1000 cst and 5000 cst silicon oil.

Myopic CNVM is a sight-threatening complication of pathological myopia. Diagnostic modalities for detecting and monitoring CNVM include FFA, OCT, and OCTA. Ohno Matsui et al.[26] recommended using OCTA in combination with either OCT or FFA for improved accuracy in detecting CNVM. This aligns with the trends of the VRSI-PAT 2024 survey, where nearly half of the respondents preferred the combination of OCT and OCTA for diagnosis and follow-up in cases of myopic CNVM. Cheung et al.[27] in their consensus statement recommended anti-VEGF monotherapy as a first-line treatment for treating a case of myopic CNVM. In the VRSI-PAT 2024 survey, ranibizumab was the preferred anti-VEGF agent for treating myopic CNVM. Approximately two-thirds of the respondents adopted a PRN regimen from the outset, while the remaining one-third initiated PRN dosing after three loading doses, similar to response from the ASRS-PAT report.[1] The REPAIR study supported a PRN dosing regimen, where patients received a single injection of ranibizumab followed by as-needed dosing based on disease activity.[28] Efficacies of ranibizumab and aflibercept are comparable with PRN dosing for myopic CNVM.[29] In the ASRS-PAT report, a recent decrease in visual acuity, new onset metamorphopsia, and fluid on OCT have been described as signs of reactivation of disease;[27] however, in our survey, the majority of respondents tend to reinitiate treatment on the appearance of new retinal hemorrhage.

MTM occurs in nearly 30% of eyes with high myopia.[4] In the VRSI-PAT 2024 survey, for Stage 1A and Stage 2 MTM, the trend was to observe, while PPV was preferred for Stage 2C. These trends are in line with the recommendations for MTM management by Parolini et al.[30] For stage 4A MMT (macular detachment without macular hole) and stage 4C (with macular hole), the trend was toward PPV. Very few respondents preferred a combination of macular buckle with PPV. Parolini et al.[30] recommended macular buckle for Stage 4A, while Stage 4C requires a combination of macular buckle with PPV.

For symptomatic foveoschisis, the majority of the respondents preferred PPV with fovea sparing ILM peeling, while in cases with a macular hole, RD secondary to MTM, PPV with ILM peeling was preferred. Shimada et al.[31] in their study reported development of a macular hole in 17% of the eyes treated with conventional ILM peeling, whereas none of the eyes treated with fovea sparing ILM peeling had macular hole postoperatively. Though literature reports successful macular hole closure and retinal reattachment with PFCL-assisted inverted ILM peeling,[32] respondents were divided on their preference for the use of PFCL-assisted ILM peeling.

The preferred choice of tamponade for myopic macular holes was nonexpansile gas in the survey. Literature has varying views on the choice of tamponade with Uemoto et al.[33] preferring the use of gas, while Nishimura et al.[34] reported better outcomes with silicone oil tamponade. For recurrent macular hole-related RD, respondents preferred revitrectomy with a free flap and were not in favor of barrage laser around the hole if ILM peel was not feasible. Wolfensberger et al.[35] in their report had reported that use of barrage laser around macular hole rim in case of macular hole RD had good anatomic results without much deterioration of visual acuity in comparison to cryotherapy or diathermy, which were used previously. However, with the use of retinal autograft[36] and autologous blood,[37] barrage laser is not favored anymore. Respondents were divided in their preference for 23G (42%) or 25G (56%) vitrectomy. Literature shows outcomes of surgery are not influenced by the gauge of instrumentation, making either a feasible option for use.[38,39]

This survey represents the preferences and practice patterns of VRSI members who participated; however, with a response rate of only 16.71%, the results may not accurately reflect the views of the entire membership, representing a significant limitation. Low response rates have been a consistent challenge in such surveys, with the previous VRSI survey in 2020 having only 107 responses,[2,3] while the ASRS PAT Global Trends Survey 2024, despite involvement from 64 societies, had just 684 respondents.[1] The reliability and representativeness of these findings would be greatly enhanced by improved voluntary participation from members.

Conclusion

The VRSI-PAT 2024 survey gives valuable insights into the preferences of trends in the management of routine pathologies encountered in day-to-day vitreoretina practice. While a majority of these align with recommendations available in the literature, some significant differences are also noted. Availability of this information for all practitioners will help peers stay up to date with current trends and keep updated on recent advances.

Meeting presentations

The results of the survey were presented as a symposium at the 33rd Annual conference of VRSI – 6th – 8th December 2024 at Guwahati, India.

Conflicts of interest:

There are no conflicts of interest.

Management of Retinal Detachment and Myopia - Practice Patterns amongst Vitreoretinal Surgeons of India - A VRSI Survey

Appendix 1

  1. Do you consider prophylactic barrage of lattices in patient scheduled to undergo refractive surgery?

    1. I barrage all lattices in symptomatic patient

    2. I barrage only lattices with atrophic holes or with clinically visible vitreous traction

    3. I barrage only lattices with atrophic holes or with clinically visible vitreous traction in symptomatic Patients

    4. I routinely barrage all lattices prior to refractive Surgery

    5. No, I do not barrage lattices prior to refractive Surgery

  2. For a break with subretinal fluid (defined as a single break with up to 1 disc diameter (DD) of fluid limited anterior to the equator), what is your preferred management approach?

    1. Barrage the break and fluid

    2. Pneumatic retinopexy if break is located superiorly and buckle if inferior in location

    3. Primary vitrectomy

  3. For subclinical retinal detachment (defined as a break with subretinal fluid (SRF) greater than 2 disc diameters (DD) limited anterior to the equator), what is your preferred management approach?

    1. Barrage laser demarcation along the margin of detachment

    2. Pneumatic retinopexy/Scleral Buckling

    3. Primary vitrectomy

  4. In a phakic eye with PVD, what would your preferred surgical approach in the following scenarios- 1) single hole, 2) multiple hole, 3) PVR grade B superior, 4) PVR grade C superior, 5)PVR grade B inferior, 6) PVR grade C inferior?

    1. PPV

    2. Pneumatic retinopexy

    3. Scleral bucking

    4. Vitrectomy with encirclage

  5. In a phakic eye without PVD, what would your preferred surgical approach in the following scenarios- 1) single hole, 2) multiple hole, 3) PVR grade B superior, 4)PVR grade C superior, 5)PVR grade B inferior, 6)PVR grade C inferior?

    1. PPV

    2. Pneumatic retinopexy

    3. Scleral bucking

    4. Vitrectomy with encirclage

  6. In a Pseudo-phakic eye with PVD, what would your preferred surgical approach in the following scenarios- 1) single hole, 2) multiple hole, 3) PVR grade B superior, 4)PVR grade C superior, 5)PVR grade B inferior, 6)PVR grade C inferior?

    1. PPV

    2. Pneumatic retinopexy

    3. Scleral bucking

    4. Vitrectomy with encirclage

  7. In a Pseudo-phakic eve without PVD, what would vour preferred surgical approach in the following scenarios- 1) single hole, 2) multiple hole, 3) PVR grade B superior, 4)PVR grade C superior, 5)PVR grade B inferior, 6)PVR grade C inferior?

    1. PPV

    2. Pneumatic retinopexy

    3. Scleral bucking

    4. Vitrectomy with encirclage

  8. What is preferred surgical management for retinal detachment with hole/ tear located superiorly in following scenarios- 1) PVR grade B or less 2) PVR grade C or more ?

    1. Laser retinopexy to hole alone

    2. Laser retinopexy to break with 360-degree laser

  9. What is preferred surgical management for retinal detachment with hole/ tear located inferiorlv in following scenarios- 1) PVR grade B or less 2) PVR grade C or more ?

    1. Laser retinopexy to hole alone

    2. Laser retinopexy to break with 360-degree laser

  10. What is preferred choice of tamponade for retinal detachment with a hoie/tear located Superiorly in following scenarios-1) PVR grade B or less 2) PVR grade C or more?

    1. Non-expansile gas

    2. Silicon oil 1000 cst

    3. Silicon oil 5000 cst

  11. What is preferred choice of tamponade for retinal detachment with a hole/tear located Inferiorlv in following scenarios-1) PVR grade B or less 2) PVR grade C or more?

    1. Non-expansile gas

    2. Silicon oil 1000 cst

    3. Silicon oil 5000 cst

  12. What is vour imaging modality of choice to diagnose and follow up cases of myopic choroidal neovascularization (CNVM)?

    1. FFA

    2. OCT

    3. OCT+OCT Angiography

    4. OCT+FFA

    5. OCT-Angiography

  13. Which anti-VEGF agent do you prefer as the first line of treatment for myopic CNVM?

    1. Aflibercept

    2. Bevacizumab

    3. Brolucizumab

    4. Faricimab

    5. Ranibizumab

    6. Ranibizumab biosimilar

  14. Following the initiation of anti-VEGF treatment for myopic CNVM, what regimen do you typically follow?

    1. 3 loading doses followed by PRN (Pro-re Nata) regimen

    2. 3 loading doses followed by T&E (Treat and Extend) regimen

    3. PRN from initiation (No loading dose)

  15. In a patient treated previously with loading doses of Anti-VEGF and maintaining Stable Vision for 6 months, when do you consider repeat injection for recurrence?

    1. New Retinal hemorrhage noted clinically

    2. Only if OCT & OCTA shows signs of reactivation

    3. Patient complaining of metamorphopsia with 2 line Drop in vision

    4. Sub-retinal Hyperreflective material (SHRM) showing fuzzy borders on OCT without Sub-retinal fluid

    5. All of the above

  16. Which OCT Scan protocol do you prefer for imaging in Myopic traction maculopathv?

    1. Horizontal and vertical Raster scan

    2. Macular cube

    3. Radial Scan

    4. All of the above

  17. What is your preferred line of management in a case of inner or outer macular schisis only without macular hole (Stage 1A or Stage 2)?

    1. Observation with follow up for drop in vision and/or increasing metamorphopsia

    2. PPV+ macular buckle

    3. Pars -Plana vitrectomy

  18. What is your preferred line of management in a case of outer macular schisis with macular hole (Stage 2C)?

    1. Observation with follow up for drop in vision and/or increasing metamorphopsia

    2. PPV+ macular buckle

    3. Pars -Plana vitrectomy

  19. Which is your preferred surgical technique in cases with Macular Detachment without macular hole (Stage 4A)?

    1. Macular Buckle

    2. Macular Buckle + Pars Plana Vitrectomy

    3. Pars Plana Vitrectomy

  20. Which is your preferred surgical technique in cases with Macular Detachment with macular hole (Stage 4C)?

    1. Macular Buckle

    2. Macular Buckle + Pars Plana Vitrectomy

    3. Pars Plana Vitrectomy

  21. Which is your preferred surgical approach in a case of symptomatic Foveo- schisis?

    1. Pars- Plana Vitrectomy + Internal Limiting Membrane Peeling

    2. Pars- Plana Vitrectomy +Fovea Sparing Internal Limiting Membrane Peeling

    3. Pars-Plana Vitrectomy only

  22. Which is your preferred surgical technique in cases with macular hole retinal detachment (MH-RD) secondary to myopic traction Maculopathv?

    1. Pars Plana Vitrectomy + Internal limiting Membrane

    2. Pars- Plana Vitrectomy only

    3. Pars- Plana vitrectomy + Macular Buckle

    4. Pars- Plana vitrectomy + Scleral Imbrication

  23. Do you prefer to use PFCL for ILM peeling in Macular hole RD?

    1. Yes

    2. No

  24. What is your preferred surgical technique in a case of Recurrent Macular hole related Retinal Detachment (MH-RD) secondary to MTM?

    1. Autologous Blood

    2. Retinal Autograft

    3. Revitrectomy + Free- Flap

  25. Which is your preferred vitrectomy gauge while doing Vitreo-Retina Surgery in High myopic patients?

    1. 23G

    2. 25G

    3. 27G

  26. What is your preferred choice of tamponade While operating a case of myopic macular hole?

    1. Denseron

    2. Non expansile gas (14% C3F8 or 20% SF6)

    3. Silicon oil

  27. ln your opinion, is there a role for barrage laser around macular hole in Macular hole RD with Axial Length > 30 mm where ILM peeling is not possible?

    1. Yes

    2. No

Management of Retinal Detachment and Myopia - Practice Patterns amongst Vitreoretinal Surgeons of India - A VRSI Survey

Appendix 2:

Table 1.

Demographic profile of respondents to the VRSI-PAT 2024 survey

Demographics
Number of respondents 287
Age (years)
Mean(SD) 42.9(9.6)
Range 29-75
Gender n (%)
Male 199(69.1)
Female 89(30.9)
Area n (%)
Urban 268(93.7)
Rural 18(6.3)
Type of practice n (%)
Government Hospital 14(4.84)
Institutional Hospital 116(40.14)
Private- Corporate Hospital 51(17.65)
Private- Individual Hospital 105(36.33)
Other 3(1.04)
Years in Vitreoretina practice n(%)
Mean (SD) 12.43(9.36)
Range 0.2 - 44
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Table 2.

Preference and trends survey data related to Retinal detachment

1. Do you consider prophylactic barrage of lattices in patient scheduled to undergo refractive surgery? n(%)
I barrage all lattices in symptomatic patient 25(8.68)
I barrage only lattices with atrophic holes or with clinically visible vitreous traction 56(19.44)
I barrage only lattices with atrophic holes or with clinically visible vitreous traction in symptomatic patients 42(14.58)
I routinely barrage all lattices prior to refractive surgery 159(55.21)
No, I do not barrage lattices prior to refractive surgery 6(2.08)
2. For a break with subretinal fluid (defined as a single break with up to 1 disc diameter of fluid limited anterior to the equator), what is your preferred management approach? n(%)
Barrage the break and fluid 262(90.66)
Pneumatic retinopexy if break is located superiorly and buckle if inferior in location 26(9.00)
Primary vitrectomy 1(0.35)
3. For subclinical retinal detachment (defined as a break with sub retinal fluid greater than 2-disc diameters limited anterior to the equator), what is your preferred management approach? n(%)
Barrage laser demarcation along the margin of detachment 131(45.96)
Pneumatic retinopexy/Scleral Buckling 121(42.46)
Primary vitrectomy 33(11.58)
Open in a new tab

Numbering as per questionnaire in Appendix 1

Table 3.

Preference and trends survey data related to Myopia

16. Which OCT Scan protocol do you prefer for imaging in Myopic traction maculopathy? n(%)
Horizontal and vertical Raster scan 65(23.13)
Macular cube 23(8.19)
Radial Scan 34(12.10)
All of the above 159(56.58)
23. Do you prefer to use PFCL for ILM peeling in Macular hole RD? n(%)
Yes 152(56.30)
No 118(43.70)
24. What is your preferred surgical technique in a case of Recurrent Macular hole related RD secondary to MTM? n(%)
Autologous Blood 18(7.09)
Retinal Autograft 59(23.23)
Revitrectomy + Free- Flap 177(69.69)
25. Which is your preferred vitrectomy gauge while doing Vitreo-Retina Surgery in High myopic patients? n(%)
23G 113(41.85)
25G 151(55.93)
27G 6(2.22)
26. What is your preferred choice of tamponade While operating a case of myopic macular hole? n(%)
Denseron 3(1.12)
Non expansile gas (14% C3F8 or 20% SF6) 195(72.76)
Silicon oil 70(26.12)
27. In your opinion, is there a role for barrage laser around macular hole in Macular hole RD with Axial Length > 30 mm where ILM peeling is not possible? n(%)
Yes 70(26.32)
No 196(73.68)
Open in a new tab

OCT- Optical coherence tomography, PFCL - Perfluorocarbon liquid, ILM- Internal imiting membrane, RD- Retinal detachment, MTM- Myopic traction maculopathy, Numbering as per questionnaire in Appendix 1

Funding Statement

Nil.

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