Alcon’s 2026 Focus Vitreoretinal (VR) symposium brought together 72 vitreoretinal surgeons and fellows from Australia, New Zealand, Fiji, and Singapore, for a day of networking, education, and discussion focused on innovation and surgical excellence.
Curated by the steering committee comprised of Professors Andrew Chang and I-Van Ho (NSW), Dr Sarah Welch (Auckland), and Associate Professor Jolly Gilholtra (SA), this year’s jam-packed program featured a keynote presentation from Professor Lee Shu Yen (Singapore) on the surgical approach to myopia, short case studies on the different aspects of VR surgery and panel discussions which attracted plenty of lively questions and interactions.
good outcomes depend on communication, managing expectations and shared decision making
Mastering Complications
The morning kicked off with a series of rapid-fire presentations on difficult and unusual retinal cases, and how to manage them.
Dr Andrew Symons (Vic) took the audience on a whirlwind tour through “weird” retinal detachment, from the prosaic to the more bizarre cases. He reminded everyone that however weird the reason, “our job as retinal doctors is to try to work out what’s causing the irrational detachment, [and]… fix the underlying problems”.
Dr Amanda Ie (NSW) spoke on the importance of detecting retinal traction in patients with retinopathy of prematurity (ROP), noting that 2% of patients still get retinal detachments (RD). The “gold standard” of treating RD is now lens-sparing vitrectomy, rather than scleral buckling, as it eliminates high myopia and the need for further surgery.
A case study on a traumatic eye injury by Dr Edward Roufail (Vic) illustrated how artificial iris implantation can provide psychological benefits to a patient, not only improving glare and visual acuity significantly, but restoring self-confidence as well.
Dr Riyaz Bhikoo (Akl, NZ) illustrated the importance of early detection of uveal tumors, particularly when cases misdiagnosed as central serous retinopathy turn out to be more malignant. He cautioned the audience to have a high level of suspicion and that early detection is key to better patient outcomes.
Prof Adrian Fung (NSW) discussed his learnings from treating a patient with severe von Hippel-Lindau-related hemangioblastoma, which led to a difficult vitrectomy and a subsequent iatrogenic macular hole. “Subretinal exudate is much more difficult to evacuate than I had ever anticipated,” he admitted. “And tying prolene inside the eye is definitely not easy.”
The session closed with Associate Professor Lawrence Lee’s (Qld) reflections on his 25 years as a VR surgeon and how the way he manages dislocated lenses has evolved. From 20-gauge fragmatomes to small-gauge vitrectomy, today’s strategies combined with smaller incisions allow for faster rehabilitation and better management of complex cases.
Shaping the Future of VR Surgery
Innovation continues to drive Alcon’s vision for the future, and the second set of presentations highlighted how new technology and insights are shaping the future of VR surgery.
Associate Professor Stewart Lake (Vic) shared an exciting application of optical coherence tomography (OCT), where metrics like macular texture and retinal shape analysis may help to identify eyes at higher risks of RD and predict which patients with epiretinal membranes may benefit from surgery. Although still in early research stages, this may have the capacity to guide surgical decisions in the future.
Although the session was about the future, Dr Jess Xiong (NSW) noted that pneumatic retinopexy, a technique introduced over 100 years ago to repair RDs, is still relevant and can achieve a superior visual recovery to vitrectomy in eyes with a superior single break. While a vitrectomy does have a higher success rate, a pneumatic retinopexy has a significantly lower cataract rate and less metamorphopsia at 12 months. She encouraged the audience to consider them and advised that choosing the right patient and a careful 360° retinal examination help to ensure a good outcome.
Dr Gaurav Bhardwaj (NSW) discussed his experience with the Ngenuity 3D visualisation system, commenting on the ergonomic advantages and reduced accommodative strain. With similar clinical outcomes to traditional microscopes, better comfort, and reduced macular phototoxicity due to increased software illumination, he concluded that “it’s become my preferred technique for performing vitreoretinal surgery, and is especially beneficial in a teaching environment”.
In emerging treatments like retinal gene therapy and cell therapy, the amount of reflux from subretinal injections is important, and Professor Matthew Simunovic (NSW) shared his research in this space. He compared two different approaches to deliver the drug, with no statistically significant difference between them, with the mean amount of drug reflux around 4%. Despite this, there was less variability in the one step approach, making it the preferred option as, “it’s fair to say that these sophisticated and expensive therapies require precise delivery”.
Being a surgeon is not only about having the right surgical skills; it also involves making the right call for a patient
Refining Surgical Skills
Keynote speaker Dr Lee Shu Yen (Singapore) shared her insights on myopic traction maculopathy (MTM). Previously known as myopic retinoschisis, foveochisis, or maculoschisis, MTM is “a clinical as well as OCT diagnosis” affecting multiple layers of the macula and occurring in up to a third of eyes with posterior staphyloma. Of all cases, 25–30% will progress to a macular hole or foveal detachment, and Prof Lee discussed the challenges of deciding whether and when to surgically intervene in patients with MTM, noting that a poorer outcome is more likely when all the macular layers become involved.
Surgical intervention to relieve traction requires careful planning and long-term monitoring, with comprehensive OCT analysis and axial length measurements. Prof Lee now leans towards foveal-sparing internal limiting membrane (ILM) peels, noting that “we used to think that peeling the ILM was quite harmless. Now we’re not so sure”. Despite these challenges, she reassured the audience not to “panic and jump into surgery. You have to tailor it to the eye, and you have to plan for the surgery, and most of the time… (you get) quite good results”.
The surgical theme continued with Dr Kolin Foo (Wgtn, NZ) recalling his journey from early 20-gauge procedures to modern 25- and 27-gauge systems, and how advances in instruments and cutter rigidity and high cut rates now make small gauge vitrectomies faster and more versatile. Despite this, “no single gauge is perfect,” he said, “you need to… mix and match sometimes”.
Dr Anthony Mak (Akl) shared his experience with a relatively new, no-tamponade macular hole procedure, using an ILM flap secured with heavy fluid. Recent studies have shown excellent results, even in large or traumatic holes, although he emphasised that he mainly “reserves this… for patients [who] really can’t posture, or particularly big holes”.
Associate Professor Wilson Heriot (Vic) expanded on the no-tamponade theme and presented innovative research on treating retinal tears. With the use of a laser that evaporates fluid under the retina, and creating a seal, this allows the retina to “pump itself down overnight” without a gas tamponade, with fewer folds and subsequent distortion, simplifying RD repair.
Dr John Downie (NSW) shared some choroidal case studies that illustrated the importance of the cannula being positioned in the right place during surgery, particularly before any fluid-air exchange. “You need to remember to anticipate the situations where it might not go into the right place and be prepared,” he cautioned.
Recognising the gap between VR surgical skills needed and the current standard of surgical simulators for training, Dr Gurmit Uppal (Qld) has spent nearly a decade working with two other VR surgeons and a visual effects company to build an anatomically correct virtual eye. Sharing his journey and beautifully illustrated videos with the audience, he demonstrated how the virtual model, named Perfect Eye, can be effective in clinical and patient education, product demonstration, as well as research.
Making the Right Decisions
Being a surgeon is not only about having the right surgical skills; it also involves making the right call for a patient.
Dr David Sia (SA) reviewed evidence on when to operate for a vitreous hemorrhage in diabetic, non-diabetic, traumatic, and special cases. He reminded the audience that early vitrectomy can be beneficial in certain cases and to always rule out tumours in children when trauma history is vague.
A presentation by Dr Vivek Pandya (NSW) focused on the human side of surgery, and that good outcomes depend on communication, managing expectations, and shared decision making. “Treat the patient,” he said, “not just their eyes”.
Tamponade gases, a mainstay in VR surgery, may become regulated in the future due to the changing climate. Dr Welch discussed the high climate impact of these gases, particularly SF6, stating that its “global warming potential is 25,000 times greater than carbon dioxide”. Alternatives, such as gases with lower warming potentials, reduced wastage, and bio adhesive, may become options. “I think the exciting thing is some of what Wilson [Assoc Prof Heriot] and other colleagues are doing,” she said, “such as sealing the break and not having tamponades.”
The vitreoretinal surgery unit that serves Fiji and the wider Pacific began in 2021 and with Dr Antonio Taufaeteau (Fiji) as the first trainee. He discussed his challenges of learning VR surgery in a setting “where most of your patients…[have] complicated PDR (proliferative diabetic retinopathy)”, late-presenting retinal detachments and “a fair bit of intraocular foreign bodies… and other penetrating eye injuries”. He highlighted the ongoing importance of regional training partnerships and the need for stronger primary care.
As a recently graduated fellow, Dr Shanil Dhanji (NSW) reflected on his transition from trainee to trainer and how this experience has shaped his framework for selecting and teaching fellows. “We’re not just trained technicians,” he said, “so emphasis should be placed on professionalism. This includes decision making, including deciding when not to operate.” Effective training requires increasing autonomy, reflection, and a safe learning culture, he said.
There were also plenty of robust panel discussions on the topics of combining anterior and posterior segment surgery; the limitations of physics and how that affects how surgeons may operate; and how virtual reality, robotics and artificial intelligence are changing surgery and sustainability, access, and equity. The night finished with the dinner and the Retinal Film Festival, which celebrated the technical skills and artistry of vitreoretinal surgery.
Stephanie Lai graduated in optometry from the University of Auckland in 2009 and completed her Graduate Certificate in Public Health and Leadership at the Australian College of Optometry in 2022. She practises as an optometrist with Bupa in Sydney, and is a regular contributor to mivision.
