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Retina Surgery Training

Approximately 700 major vitreoretinal surgeries are performed annually. Proliferative diabetic retinopathy, epiretinal membranes, full-thickness macular holes, and rhegmatogenous retinal detachments are the leading indications though endophthalmitis, proliferative vitreoretinopathy, diabetic traction detachments, vitreous hemorrhages, post-trauma/IOFBs, and other etiologies are frequently encountered.

During this Fellowship, the vast majority of surgical procedures will be performed in large part, if not fully, by the Fellow. As fellows will have the rest of their careers to operate alone (depending on their practice environment), faculty directly supervise fellows for all cases—this allows the faculty and fellow to discuss the plan in advance of the case and debrief afterward in a manner that is most conducive for the fellow to yield the maximal amount of learning possible from each case. Intraoperative digital recordings are done for all cases so they can be reviewed and presented at conference to improve techniques and facilitate discussion amongst faculty.

Thus, all retina surgeries are done under one roof of interconnected hospitals with 95% of cases being done in the ASC, which is located 3 floors directly above the eye clinic. Fellows do not do clinics or operate at any other facilities than our inter-connected hospital system (i.e. no commuting between hospitals or different clinic sites is done by retina fellows).

State of the art equipment that is the standard at University of Iowa in the OR includes:

  • Alcon Constellation and Dutch Ophthalmic (DORC) Eva vitrectomy systems (23-27 gauge)
  • 3 Zeiss Lumera scopes equipped with Resight wide-angle viewing system and Rescan intraoperative OCT (handheld contact lenses are also available)
  • Standard complement of vitrectomy instruments such as macular lenses, vertical/horizontal/curved scissors, ILM peelers, PVR forceps, chandeliers for bimanual peeling, membrane pics, diamond-dusted scrapers (Tano and Sapphire), multiple IOFB forceps, intra- and extraocular magnets, straight and curved illuminated endophotocoagulators, indirect laser, intraocular cryoprobe, silicone oil, perfluorocarbon liquids, etc.
  • Scleral buckle materials

Trial of new, FDA approved instruments are done frequently at UI Hospitals & Clinics in the retina OR.

There is a wet lab with microscope (with BIOM) and surgical simulator with the vitreoretinal module (EyeSi VR Magic) available for use by the surgical fellows. Multiple wet lab sessions at University of Iowa have allowed future technologies to be tested by fellows and faculty.

During the Fellowship, the majority of surgical procedures will be performed by the Fellow under the direct supervision of a member of the faculty. Intraoperative digital recordings can be done on all cases for presentations and used to review and improve techniques.

Eye OR Team

In 2019, the UI Hospitals & Clinics and department of ophthalmology approved the creation of an eye OR team that consists of RNs and techs dedicated to ophthalmic surgery, including retina. This eye OR team is based in the ASC thus retina surgeries are currently being transitioned for over 95% of cases which should greatly limit night and on weekend surgeries with the exception of true retinal emergencies. On-call cases at night and on weekends will be in the main operating room but have the support of the same eye OR team members. Surgeries involving children are performed in the University of Iowa Stead Family Children's Hospital.

Eye OR Team group

Wet and dry retina surgery labs

We have several types of simulation labs with microscope (and wide-angle viewing systems) and surgical simulator with the vitreoretinal module (EyeSi VR Magic) available for use by the surgical fellows. Wet lab sessions at the University of Iowa have allowed future technologies (that haven’t been released to the public yet like intraoperative OCT, vitrectors, forceps, etc) to be tested by fellows and faculty. We also have synthetic eyes with human model heads that can be used for vitrectomy and membrane peeling to facilitate better hand/head positioning, foot pedal familiarity, and surgical techniques

Elaine Binkley, MD

Above is faculty member Elaine Binkley, MD, demonstrating flawless technique on the EyeSi VR Magic vitreoretinal surgical simulator when she was a fellow