Q&A: María Berrocal's Ingrid Kreissig Award Lecture at EURETINA 2025

(Photo of Maria Berrocal at the 2025 EURETINA meeting in Paris, France)

María Berrocal, MD, from Drs. Berrocal and Associates in San Juan, Puerto Rico, delivered the Ingrid Kreissig Award Lecture titled "Throwing away wisdom: How we abandon what works" at the 2025 EURETINA meeting in Paris, France. Her presentation focused on 2 medical techniques that she believes have been wrongly replaced by newer, less effective methods.

Note: The following conversation has been lightly edited for clarity.

Ophthalmology Times: You are presenting the Kreissig Award Lecture here at EURETINA 2025. Can you tell us what you will be discussing?

María Berrocal, MD: I am most honored to receive the Ingrid Kreissig Award Lecture. In that lecture, for those who may not know, Ingrid Kreissig was instrumental in bringing us cryotherapy, the minimal buckle surgery, and she was the first to describe pneumatic retinopexy. In my lecture, which is titled, "Throwing away wisdom: How we abandon what works," I'm going to talk about 2 techniques that actually give better results than other things that they have been replaced with.

One of them is the minimal, non-drainage scleral buckle procedure for retinal detachments. We get success rates of up to 97% with a single operation hen we use a minimal non drainage buckle procedure. The visual acuity results are better than with primary vitrectomy, and the complication rates are much less. So what this tells us is that we really should be doing a smaller procedure which has a smaller carbon footprint and is actually requires much less equipment and gives us better results. So I will talk about all of the data that we have supporting this procedure that should not be abandoned.

The other part of my lecture will be about pan-retinal photocoagulation as the standard treatment for proliferative diabetic retinopathy. Pan-retinal photocoagulation has been used for over 40 years, and we know that it provides stability to eyes, just with a few treatments, long-term stability, almost for life and with very good visual acuity results. Sadly, it has been replaced by some physicians with monthly injections. The problem with monthly injections is that the effect is only temporary. So treating a disease that is life long and that requires regression of neo-vessels with a temporary procedure that requires travel, compliance, multiple visits every year, almost for life, in my mind, doesn't make sense when we have an older procedure that provides long-term, long-term stability.

Well, you know, I love adopting new things, and I love vitrectomy. I really love vitrectomy for severe diabetic complications. But I also see what happens when patients are lost to follow-up, and we know that in the United States, many patients don't have the means or are lost to follow-up because they get sick, etc, and I have seen so many eyes get lost when, for example, the patient is being treated with anti-VEGF injections, and they become sick, and they can't come in for 6 months, and then they come in with neovascular glaucoma and a lost eye. I have never seen, and I've been practicing for over 30 years, and I had never seen some of these complications that we see when you're lost to follow-up when we were treating with laser.

I decided to look into this and realized that, you know, oftentimes we go into what's novel, what's new, what's in vogue, and we forget about what's really best for the patient and the reality of the patient. The same thing with this scleral buckle. The reason I decided to abort this is because I had 1 patient that I did a vitrectomy in 1 eye had a very complicated detachment. He was, you know, face down with gas for about over a month, and then about a year later, he develops a detachment in the other eye. I said, you know, I'm going to do a different procedure. I'm just going to put a little piece of sponge in your eye. I won't drain or anything, because this detachment is smaller. So I did that, and the next day, he comes, I can't believe you did this to me. So I thought he was referring to scleral buckle, but no, he was actually talking about, no, that other horrible procedure. I was a month without being able to go-to work. My neck was killing me. He developed a cataract, and so he was, so then I decided to look at, you know, the time that patients have to take up work, how disabled they are. Well, they can't see anything with gas in their eye, et cetera, and realized that actually doing a minimal procedure is actually not only gives us better single surgery success rates, but actually it's much better for the patients, because they can go on with their lives very quickly. I hope that they take with them that when you get a rheumatogenous retinal detachment that just has one or a few breaks, that a little piece of radial or segmental sponge without drainage is probably what's going to give the patients the best visual acuity results, the best single surgery success rates, and the best visual acuity outcomes. I also want them to take back that the standard of care of proliferative diabetic retinopathy is pan-retinal photocoagulation with laser. Nothing else, you know. This stabilizes eyes, almost for life. It has minimal complications, and it does not require constant follow-up of the patients and multiple visits.