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13.6 Fundamental Steps andMatters Needing Attention
Fig. 13.7 Double-click the video segment in Area D to adjust the playback speed in Area C
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which improves video quality. Note: If the original video has too low magnication, post-cropping will reduce clarity and may cause noise.
2. Playback speed: Adjusting playback speed is another key part of image adjust-
ment. Based on long-term experience, doubling the original speed (2×) is optimal; dynamic adjustments can be made for key steps (Fig.13.7).
(6) Adding Transitions
Transitions connect different surgical steps, improve video uency, and attract
viewers’ attention (Fig.13.8).
(7) Adding Subtitles
Subtitles play an important role in surgical video presentation. They should be accurate and concise, with no excessive effects (Fig.13.9).
(8) Adding Audio or Narration
Audio and narration are not mandatory for surgical videos—editors can decide
whether to add them based on specic needs. Audio enhances the video’s atmosphere and viewers’ immersion, but its style and volume should be appropriate to
avoid overshadowing the main content. If needed, add narration: it should be concise and progress with the video’s plot (Fig.13.10).
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Fig. 13.8 Select a transition effect in Area A, drag it between two video segments in Area D, and
adjust the transition duration in Area C
13 Editing andPresentation ofSurgical Videos
Fig. 13.9 Select a subtitle template in Area A, drag it above the video segment in Area D, enter
the subtitle content and adjust its size/position in Area C; view the adjusted effect in Area B
13.6 Fundamental Steps andMatters Needing Attention
Fig. 13.10 Drag audio from Area A below the video segment in Area D; adjust audio effects (e.g.,
volume, fade-in/fade-out time) in Area C; click the “Record” button in the upper left corner of Area
D to record narration
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Fig. 13.11 Parameters in the red box include resolution, bitrate, codec, format, frame rate, etc.
(9) Saving the Video
After previewing the video and conrming it meets expectations, click the “Export”
button in the upper right corner of the software interface. Enter the video parameters
and save the le to the hard drive (Fig.13.11).
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13 Editing andPresentation ofSurgical Videos
13.7 Protection ofPatient Privacy andIntellectual Property
With the rise of online platforms, the internet has become an important channel for
surgical video dissemination. While we can access various multimedia resources
online to enhance the professionalism and interest of surgical videos, this also
brings risks such as patient privacy leaks and intellectual property infringement.
When creating videos involving specic patients, blur or remove their personal
identication information. If the patient’s face must be included, cover key areas
(e.g., eyes) to prevent identication.
Multimedia les may involve intellectual property in the following aspects:
1. Fonts: Avoid unauthorized fonts—this issue has received increasing attention in
online works in recent years.
2. Background music: Most online music is protected by intellectual property
rights—avoid infringement when selecting music.
3. Video clips: Editors sometimes insert guiding or interesting video clips into sur-
gical videos, which carries signicant infringement risks and should be avoided.
13.8 Showcase Your Art Works
Surgical videos can be presented through multiple channels, mainly including the
following:
1. Case presentations: The most common method. Surgical videos are usually
inserted into slides and presented with key case points. Note: Videos should be
concise, with clear key points and no excessive artistic effects; they should align
closely with the slide text.
2. Academic conferences: Due to their high academic value and interest, surgical
videos have become increasingly attractive in academic events at all levels. As
overall production standards improve, requirements for case quality and editing
techniques have also risen.In China, the inuential “Zeiss Film Festival” of the
Retina China Forum; internationally, the well-known “Film Festival” of the
American Society of Retina Specialists (ASRS) are major platforms.
3. Professional journals: Surgical videos are published as electronic supplements
with manuscripts to better describe case characteristics and surgical details. This
increases the manuscript’s information content and conveys more accurate and
intuitive knowledge. Some professional journals accept video-focused submissions—for example, RETINA has a “Surgical Technique” section dedicated to
new surgical techniques and methods.
4. Online platforms: In recent years, surgical videos are often shared as short vid-
eos on major social media platforms. However, due to the lack of strict peer
review and screening, the content quality varies greatly, and the information conveyed is often single—there is signicant room for improvement.
13.9 Summary
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13.9 Summary
‘‘A picture is worth a thousand words, but a well-edited video tells the soul of a
story.’’This chapter provides a comprehensive framework for the fundamental concepts and technical workows of surgical video production.
To excel in this digital medium, editors must move beyond simple documentation and strive for professional excellence through the following pillars: (1)
Mastering the intricate functionalities of professional editing software to ensure a
polished nal product; (2) Prioritizing originality and academic rigor to maintain
the integrity of clinical evidence; (3) Strategically aligning the narrative structure
with specic presentation scenarios and target audiences; and (4) Leveraging creative storytelling to transform technical maneuvers into engaging educational
experiences.
By synthesizing these elements, surgeons can share compelling cases with the
global community, foster the exchange of innovative surgical methodologies, and
ultimately enhance the vitality and depth of academic discourse in the eld of vitreoretinal surgery.
Part III
Vitrectomy in Europe
General Introduction toVitreoretinal
Surgery inEurope
14.1 Education ofVitreoretinal (VR) Surgery
Cataract surgery is two dimensional and VR surgery is three dimensional. What
does this mean? In cataract surgery as well as in VR surgery surgical performance
is one key factor. But in VR surgery the assessment of a retinal case is a second key
factor. A wrong assessment in VR surgery can easily result in a failed surgery. You
must think twice before surgery. I have seen so many complications because VR
surgeons pushed the vitreous cutter into the eye without reecting the underlying
pathology and then realizing that they cannot cope.
In cataract surgery the assessment is easy because the nucleus is clearly visible.
But in VR surgery, the pathology may be hidden behind a vitreous bleeding or a
dense cataract. In cataract surgery the timing is of minor importance. In VR surgery
the timing is of major importance. In the case of a retinal detachment or a orid
PDR, the approach and timing are of essential importance. Vitreoretinal surgery is
25% thinking and 75% surgery.
In Europe we start surgical education with cataract surgery. Then some cataract
surgeons continue with vitrectomy. For vitrectomies the beginner starts with silicone oil removal and core vitrectomies. The next step is membrane removal and
easy retinal detachments. The following steps are buckle/vitrectomy and easy diabetic vitrectomies.
The next step is a big step and requires mastering PVR detachments and tractional diabetic retinopathies. These pathologies require the bimanual peeling technique with a chandelier light.
14
14.2 Easy andDifficult Vitrectomy
In my working career, I have worked in three University hospitals and seen many
different vitrectomy schools. And I have seen many complications. The cause of
these complications is only partially due to poor surgical quality but especially due
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2026
Z. Zhang, U. Spandau, Vitreoretinal Surgery,
https://doi.org/10.1007/978-3-032-25271-5_14
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14 General Introduction toVitreoretinal Surgery inEurope
to wrong surgical approach and technique. Which pathologies have most frequently
a complication? PVR detachments and tractional diabetic retinopathy. These pathologies I consider and classify as difcult vitrectomies, whereas (almost) everything
else are an easy vitrectomy. The exceptions are rare cases such as pediatric cases
and trauma cases.
Peeling vitrectomies are easy vitrectomies, focal detachments are easy vitrectomies, and diabetic vitreous hemorrhage with complete PVD is aneasy vitrectomy.
In contrast, PVR detachments with stiff retina and preretinal and/or subretinal membranes are difcult vitrectomies. Diabetic eyes of young patients who never visited
an ophthalmologist, which were never scatter laser treated and have vitreoretinal
tractions, are difcult vitrectomies.
The latter pathologies should only be operated by experienced surgeons, and I
can very much recommend to visit excellent vitrectomy clinics to observe and experience their surgical approach and quality.
In general, I recommend to visit excellent vitrectomy hospitals. You must experience excellent vitrectomy surgery and know the standard for high quality vitrectomy surgery. How do you otherwise know if a failed eye was your mistake or fate.
Personally, I consider a failed eye as a personal mistake until the opposite is proved.
This means that I search for surgical mistakes, wrong approaches, and wrong indication. As a surgeon you always make mistakes, but it is very important to avoid the
same mistake a second time.
14.3 Cataract Surgery andVitrectomy
The easiest eye for vitrectomy is a pseudophakic eye. Why? Firstly, the view to
fundus is perfect. Secondly, the anterior vitreous can be completely removed and
there is no risk of damaging the posterior lens capsule. This is especially important
in vitreous bleedings. The anterior bloody vitreous can be completely removed, and
there is no optical obstacle to core vitrectomy. In contrast, in a phakic eye, you can
barely see the retina because the anterior bloody vitreous cannot be removed. The
removal of anterior vitreous is also important in retinal detachments. It reduces the
risk for redetachments. Thirdly, the peripheral vitreous and anterior hyaloid can be
completely removed in a pseudophakic eye. All this is not possible in a phakic eye.
In peeling vitrectomies, we remove the lens in patients over 60years of age. In
retinal detachments we remove the lens in patients over 50years of age, and in diabetics we remove the lens in patients over 40–45years of age.
When should the cataract surgery be performed? Before, combined or after vitrectomy? The simple answer is before. Why? Cataract surgery is easiest before vitrectomy because the vitreous supports the nucleus. If cataract surgery is performed
before vitrectomy, then the IOL is stable in a brotized lens capsule when performing vitrectomy. Combined phaco/vitrectomy is the second-best choice. The advantage is that the patient undergoes only one surgery. The disadvantage is that the
anterior chamber is unstable during vitrectomy. If you insert the trocar cannulas, the
anterior chamber collapses, and an IOL dislocation is possible due to gas
14.3 Cataract Surgery andVitrectomy
285
tamponade or impression of sclera. Everybody who has already operated on cataracts in a vitrectomized eye has experienced how difcult surgery is and how much
the risk for complication rises. The cataract is harder and the anterior chamber
very deep.
Time interval between cataract and vitrectomy: One week time interval between
cataract surgery and vitrectomy is sufcient.
In Conclusion For planned vitrectomies we send the patient to a cataract surgeon
for lens removal and then perform vitrectomy in a pseudophakic eye. In emergency
vitrectomies we perform combined phaco/vitrectomy. In diabetics we combine cataract surgery and anti-VEGF injection. The vitrectomy is usually performed
1month later.
In the following chapters, I will show step-by-step how to perform an easy and
difcult vitrectomy for retinal detachment and diabetic retinopathy.
All videos for my surgery can be found on my YouTube channel: Please nd my
playlists:
The playlist for detachment surgery is https:/ / youtube. com/playlist?list=PL0
dKYclPD7yMn861X0g-aHCS6KZ5NcH1N&si=_jtQa_sWVJL1PMe3.
The playlist for diabetic surgery is https:/ / youtube. com/playlist?list=PL0dKYcl
PD7yM9qRjBoF1HMwtxFfbf2T6A&si=VIFMlS6XzusriySr.
Combined Phaco/Vitrectomy
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A rhegmatogenous retinal detachment (RRD) with multiple breaks is a surgery for
experienced surgeons, as there is a signicant complication prole. The beginner
should start with a localized detachment (one to two quadrant detachment and a
single break), as this is usually easier to manage.
Regarding surgery, we recommend two things, which simplify vitrectomy very
much: phacoemulsication and usage of a chandelier light. We recommend performing a phacoemulsication in all patients older than 50years because the anterior vitreous and the vitreous base can be removed completely. See our treatment
algorithm (Fig. 15.1). Secondly, we recommend the usage of a chandelier light
because it facilitates every step of the vitrectomy. A complete removal of the anterior vitreous is only possible after the removal of the natural lens. Visualization and
removal of the vitreous base is easier with chandelier light. The retinal breaks are
located in the periphery and need to be indented with the scleral depressor: Nobody
indents as well as your second hand.
PFCL or no PFCL?
Some vitreoretinal clinics use PFCL as a routine; others don’t. PFCL is an excellent
tool for vitreoretinal surgery and we recommend using it, if necessary. We use PFCL
in large, macula-off detachments, and we work without PFCL in focal, macula-on
detachments. In giant tears we always use PFCL due to the risk of slippage.
25G or 27G?
27G is superior to 25G in myopic eyes. 27G sclerotomies require no suture. Myopic
eyes tend to leak and 27G sclerotomies have only minimal leakage. Minimal leakage results also in improved gas tamponade. The disadvantage of 27G is the soft
instruments. In normal eyes a 25G cutter is therefore recommended. Another advantage is thatpassive aspiration with the uid needle is more efcient with 25G than
with 27G.
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2026
Z. Zhang, U. Spandau, Vitreoretinal Surgery,
https://doi.org/10.1007/978-3-032-25271-5_15
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