The field of retina has often been likened to the Wild West by conference speakers, usually to convey the sense of expansion, discovery, and reinvention for which our field is known (we tend to ignore the unsavory traits that also defined America’s Wild West of the 1800s).

We aren’t out here gunslinging and robbing banks, so perhaps a more appropriate and tech-savvy analogy would be that of space exploration. Remember the first vitrectomy performed by the great Robert Machemer, MD, on April 20, 1970? That was 9 months, to the day, after we landed on the moon.1,2 It took us longer to invent modern vitreoretinal surgery than it did to set foot on a space rock. To be fair, the first retinal detachment repair was back in 1929.3

In 2019, about 50 years after the moon landing, NASA provided the first look at a black hole, and in May of this year we got our first glimpse of the black hole at the center of our own Milky Way galaxy.4

In the OR, we are forging ahead with our own discoveries, many of which are made possible by similar advances in imaging. Retina surgeons have 3D surgery, intraoperative OCT, and novel subretinal and suprachoroidal delivery approaches. We even have gene therapy, and researchers recently implanted a patch of stem cells to treat geographic atrophy.5 It’s the stuff science fiction is made of… and it’s already in some of our ORs.

All of this is possible because retina specialists are explorers at heart. We love solving our patients’ problems and saving their vision in the process. That mentality leads to constant innovation, whether that’s for our tools, therapeutics, or surgical techniques. What’s particularly fun about innovating in the retina space is that much of it happens as part of our day-to-day practice. Sure, we have a robust and ever-expanding pipeline of clinical research, but just as much is discovered by trying something new during a challenging surgical case.

This is why case presentations, lightning rounds, and surgical video contests are always well attended at retina meetings—and can get a bit raucous at times. Not everyone rolls in with a wriggling worm surgery (see last issue’s Global Perspectives column to see what we mean), but many still elicit gasps, oohs and ahhs, or applause from the audience. Others spark lively debates on the best approach and novel techniques that panelists and attendees have employed with success.

That’s the kind of excitement for surgical innovation we wanted to capture within these pages. In this issue, our expert authors cover surgical approaches for everything from recurrent macular holes and secondary IOLs to non-diabetic vitreous hemorrhage, macular buckling, and an extruded scleral buckle in bad shape.

Whether you are new to practice or have been around the block a time or two, we hope these techniques, tips, and tricks broaden your expertise in the OR and give you new ways to solve the complex cases that roll in. We also hope they spark your own thirst for innovation because, like our friends at NASA and their interstellar exploration, we have much left to discover about the retina and our field as a whole.

1. Blodi CF. David Kasner, MD, and the road to pars plana vitrectomy. Ophthalmol Eye Dis. 2016;8(Suppl 1):1-4.

2. Britannica. Apollo 11. www.britannica.com/topic/Apollo-11

3. Gonin J. Le traitement opératoire du décollement retinien. Conférence aux journées medicales de Bruxelles. Bruxelles-Med. 1930;23(17).

4. Event Horizon Telescope. Astronomers reveal first image of the black hole at the heart of our galaxy. May 12, 2022. Accessed September 15, 2022. eventhorizontelescope.org/blog/astronomers-reveal-first-image-black-hole-heart-our-galaxy

5. First US patient receives autologous stem cell therapy to treat dry AMD [press release]. September 2, 2022. Accessed September 15, 2022. eyewire.news/news/first-us-patient-receives-autologous-stem-cell-therapy-to-treat-dry-amd