Recently, I had the great honor of visiting my friend and colleague, Dr. Kazuaki Kadonosono, at Yokohama City University Medical Center as a guest lecturer for the Yokohama Retina Council. It was an incredible experience from start to finish, from a unique tour of a Shinto shrine with beautiful views in Kamakura to fantastic lectures and interesting case discussions. 

The day started off with a rare opportunity to observe Dr. Kadonosono in the operating room, where he demonstrated why he’s considered such a renowned master surgeon. He had several cases, including one case of myopic traction maculopathy where he performed a foveal-sparing internal limiting membrane peel and another complex case of a diabetic tractional retinal detachment. 

Observing the similarities and differences in our approaches was fascinating. For one thing, unlike in the United States, all phakic cases had simultaneous phacoemulsification with intraocular lens implantation. Another interesting difference is that patients had minimal sedation even during the retrobulbar block, yet appeared to remain very calm and steady throughout each case. 

Dr. Kadonosono’s approach to diabetic TRDs followed the standard teaching: Relieve all traction. But how one relieves the traction is always the most interesting. More than almost any other surgery, the approach to diabetic TRDs is an outlet for creativity and surgical finesse. 

We often have to employ multiple techniques that we’ve learned over the years into a single case, including membrane peeling, segmentation, delamination, hyaloidectomy, vitreous detachment, endodrainage, laser, etc. 

Dr. Kadonosono performed much of the delamination using bimanual technique, often employing just forceps and the cutter, with the cutter acting as a type of blunt pick at times to separate the membrane from the plane of the retina and scissors at other times when he identified a peg that would not easily release. I thought it was ingenious, rather than having to pull out another instrument like scissors or a separate pick. 

In this issue, we have a terrific article written by our colleagues, Drs. Pradeep Prasad, Kirk Hou and Steven Schwartz, that delves into more of the intricacies of this type of surgery. 

“In the middle of every difficulty lies opportunity,” is a quote attributed to Albert Einstein that’s very apropos for dealing with these types of complex cases. They really push us to our limits and encourage innovation to achieve the best possible outcomes for our patients. RS