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Vitreoretinal Surgery
Underlying Logic and Basic Skill
ZhaotianZhang UlrichSpandau
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Vitreoretinal Surgery
An oil painting by Zao Wou-Ki embodies the harmonious coexistence of tranquility and passion, as well as the boundless vitality born from their fusion. For us as vitreoretinal surgeons, these same qualities are essential to our craft.
ZAO Wou-Ki (1920–2013)
25.04.88, 1988 Oil on canvas, 200 × 162cm Private collection © Zao Wou-Ki, ProLitteris, Zurich– Reserved rights
ZhaotianZhang • UlrichSpandau
Vitreoretinal Surgery
Underlying Logic andBasic Skill
ZhaotianZhang Zhongshan Ophthalmic Center Sun Yat-Sen University Guangzhou, China
UlrichSpandau Ophthalmology University of Uppsala Uppsala, Uppsala Län, Sweden
ISBN 978-3-032-25270-8 ISBN 978-3-032-25271-5 (eBook)
https://doi.org/10.1007/978-3-032-25271-5
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2026
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and trans­mission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publica­tion does not imply, even in the absence of a specic statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
If disposing of this product, please recycle the paper.
This book is dedicated to my mentor, Professor Shaochong Zhang, with thanks for his kindness and motivation; to my idols, the painter Zao Wou-Ki and the architect I.M. Pei, for their inspiration in bridging East and West; to my dear friends Ulrich Spandau and Geoffrey Emerson for their great encouragement; to every colleague at Zhongshan Ophthalmic Center for their constant support; and to my family, for their unfading love.
—Zhaotian Zhang, MD, FASRS

Foreword 1

It is a pleasure to introduce this textbook of retinal surgery techniques for my friends and colleagues, Zhaotian Zhang and Ulrich Spandau.
This book offers introspective guidance for aspiring retina surgeons as they embark on and mature in their careers, emphasizing continuous learning, resilience, and composure. Retina surgery is a eld that blends profound reward with frequent challenge and periodic failure.
Learning and mastering vitreoretinal surgery requires both solid theoretical knowledge and extensive practical training. There is no substitute for surgical expe­rience and great mentors. Surgeons must cultivate deep understanding, humility, and patience—prioritizing careful judgment over speed.
The learning curve of a retinal surgeon is steep. Even steps that seem simple at rst can hide complexity and risk. An open-minded and pragmatic attitude is essen­tial in surgery, so that we may adapt to new techniques in an ever-changing eld. Nevertheless, surgical situations are not always predictable. Sometimes a surgeon can surmount a tricky situation by remembering an old technique, or a case they saw or heard of from a predecessor.
Vitreoretinal surgery remains a growing and demanding eld. The authors encourage approaching it with optimism, respect, and a commitment to technical excellence as well as compassion for patients. As an aspiring surgeon myself, I appreciate this philosophy and take it to heart. I am also grateful to have this insight­ful and comprehensive text at my side for moments when I need a suggestion or even a quick review of the basics. Thank you and bravo, Zhaotian and Ulrich.
GeoffreyG.Emerson, MD, PhD Minneapolis, MN, USA
vii

Foreword 2

In the intricate microcosm of the eye, vitreoretinal surgery represents one of medi­cine’s most profound intersections of art and science. It is a discipline in constant ux, where technological innovation and rened clinical wisdom converge to restore not just sight, but hope for millions. This book, a collaborative endeavor between leading experts from Uppsala University Hospital and the Zhongshan Ophthalmic Center (ZOC), is conceived in this very spirit of dynamic evolution.
It is a natural extension of the Bright-X—a cultural and strategic philosophy I have distilled to guide our mission at ZOC.The name Bright-X encapsulates a dual commitment: intellectually, it stands for Borrow & Build, Road & Reach, Intelligence & Integration, Global & Governance, Health & Happy, Technology & Talent, and Cross & Unknown. Politically, it resonates with a broader vision: Belt & Road Initiative: Great Health Together. It is our belief that by illuminating the path for global ophthalmology, we can advance the health of nations along the Belt and Road and beyond, fostering a world where shared knowledge leads to shared well-being.
As the largest public ophthalmic hospital in China, the sole ophthalmic specialty hospital administered by China’s National Health Commission, and the World Health Organization Collaborating Center for Eye Care and Vision in China, ZOC has long been recognized as a leader in ophthalmic care. In November 2024, we took another historic step forward with the ofcial inauguration of the International Ophthalmology Medical Center, a landmark initiative designed to serve as a global platform for cutting-edge research, talent cultivation, and cross-border collabora­tion in eye health.
Our commitment to research excellence is reected in our sustained global impact. According to the Nature Index annual rankings, ZOC has ranked rst in the world among all ophthalmic institutions for three consecutive years since 2023. This unprecedented achievement in both Health Sciences and Biological Sciences underscores our dedication to advancing the frontiers of ophthalmic science and translating discovery into clinical impact on a global scale.
ix
x
Foreword 2
Beyond our research and clinical achievements, ZOC takes pride in its role as a bridge connecting ophthalmic communities across continents. As the headquarters of the Asia-Pacic Academy of Ophthalmology and the President Ofce of the Afro-Asian Council of Ophthalmology, we have long served as a convening force for dialogue and collaboration among eye care professionals across Asia, Africa, Europe, and the Americas.
The foundation of this work is rooted in Borrow & Build. It respectfully borrows from the foundational knowledge laid by pioneers while building upon it with the rich, collective clinical experience of both Chinese and European masters. By weav­ing together the vast surgical volumes seen at ZOC with the rened techniques of Uppsala, we have built a guide that transcends any single institution’s perspective.
This book, therefore, paves a new Road & Reach. It charts a clear educational pathway for surgeons at every level, from the novice grasping the underlying logic of vitrectomy to the seasoned expert navigating complex pathologies. Our reach extends from our operating rooms in Guangzhou and Uppsala to the global com­munity, embodying the “Road” in our philosophy—connecting colleagues and patients across continents in a shared pursuit of excellence.
This endeavor is powered by Intelligence & Integration. The book integrates core physical principles with cutting-edge surgical methodologies. But more than that, it reects a deep integration of minds—combining European rigor with Asian innova­tion to foster the clinical intelligence that denes wise, adaptable surgeons.
As a World Health Organization Collaborating Center and the headquarters of leading international ophthalmic societies, ZOC bears a profound responsibility in the realm of Global & Governance. This book is a tangible expression of our com­mitment to global eye health governance. By sharing knowledge and setting educa­tional benchmarks, we actively contribute to the “Great Health Together” vision, fostering the cross-border collaboration essential to addressing the universal chal­lenge of blindness.
Ultimately, our goal is Health & Happy. Every principle detailed, every tech­nique analyzed, is in service of this singular outcome: restoring healthy vision and, with it, the happiness and quality of life for patients worldwide.
This achievement would not be possible without our most valuable asset: our people. It underscores the critical importance of Technology & Talent. While we embrace technological advancement, we rmly believe it is most powerful when wielded by talented, well-trained hands—the very hands this book seeks to cultivate.
Finally, this project is a venture into the Cross & Unknown. It is a cross-cultural partnership that enriches us all. By venturing into the unknown territories of com­plex diseases together, we model the very collaboration that will unlock the future of medicine.
Published with Springer Nature, this book marks a signicant milestone in ZOC’s journey as a global leader in ophthalmology. It is our hope that Vitreoretinal Surgery: Underlying Logic and Basic Skill serves not as an endpoint, but as a
Foreword 2
xi
catalyst for future discoveries. At ZOC, we stand ready to deepen these global part­nerships, to share Chinese wisdom and Asian solutions, and to continue our shared journey toward a world where no one is needlessly blind.
Hao-tianLin, MDDirector, Zhongshan Ophthalmic Center (ZOC) President, Zhongshan Ophthalmic Center Hospital Sun Yat-sen University Guangzhou, China