Q&A: Mario Romano discusses temperature during vitrectomy

Mario Romano, MD, PhD, a researcher from Humanitas University in Italy, discusses work on temperature control during vitrectomy. His research, supported by the Italian Ministry of Research, reveals significant temperature drops during eye surgery that can cause iatrogenic damage. Romano has developed a device to manage intraocular temperature and fluid exchange, potentially improving surgical outcomes for patients, especially those with diabetes or myopia. His focus is on enhancing surgical safety through methodical approach and technological innovation.

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

Ophthalmology Times: Can you share what you are discussing at the 2025 EURETINA meeting?

Mario Romano, MD, PhD: One of the topics that I presented on at EURETINA was the temperature control during the vitrectomy. So, we know that safety is the main issue. The main point is to try to avoid any iatrogenic damage induced by our surgery.

OT: Can you summarize this research?

Romano: We control the intraocular pressure. We control many things during the surgery, but not the temperature at all. So that's why [for] 10 years, we have had support by the Italian Ministry of Research, and we have been looking in to the changes in temperature during the vitrectomy. We found that there are about 10 Celsius degrees of temperature changes during the victrectomy. This means deep hypothermia and the fluctuation. Deep hypothermia brings some problems, because deep hypothermia means the temperature goes below 32 [degrees Celsius]. There is also the fluctuation, ischemia and perfusion problem. So that means...we have a reduction of ocular perfusion pressure during the vitrectomy, and we have some ischemia. So, in diabetic patients, myopic patients, this can be a problem. That's why we developed this device. We tested the device. We can, first of all, change the temperature and, also, the fluid exchange. So means we can change the vapor pressure. An example, if we do [perfluorocarbon liquids] exchange, we have some perfluorocarbon liquid left as we usually have. We can change the temperature. We can change the vapor pressure of the perfluorocarbon liquid, just opening the valve of the trocar. We can remove all the residual perfluorocarbon liquid left in the vitreous cavity. Then, we can have also the biological advantages...We did a pre-clinical study on rabbits, and we found that if you have control of temperature, you have better perfusion and blood supply [to] the retina. Whereas with no temperature control, like the surgery that we are doing [currently], we have more...inter-retina damage, with increasing of [Glial Fibrillary Acidic Protein] GFAP production and also, you know, some damage, like the occlusion of the vessels. This was clear in ERG findings and also on histological findings that [had available] in this study. So that's why, you know this control of temperature. We have just preclinical data, but we want to run a Phase 1 clinical trial to better address this issue.

Think about, if we residual perfluorocarbon liquid inside the eye, we can get inflammation, and macular edema. So if we reduce the amount of residual active compound that we leave inside eye, we can [improve] recovery for sure. In terms of inflammation, inflammation means macular edema and many other things. In the long term, then, you know, ischemia and hypoperfusion, like in patients with diabetes or myopia, that is not a great blood supply, the hypoperfusion, can get...worse recovery in the long run. So I mean, the point is, we cannot tell, this is still our hypothesis, because we have no data on human eyes. This data comes from the pre-clinical study on cells and on the rabbits. So this is the hypothesis, and so we need to see if it's the right one.

OT: What advice do you have for young surgeons?

Romano: [My] first advice is to look first for the safety of the procedures. So it's not just a matter of skills, you must think about...what to do. And you know, sometimes it's better to [plan] what we need to do according to the pre-clinical findings. This is the main point, because...the manual skills will come, and will be easy to get. The point is, if you have a methodological [approach], you know, mistakes, errors...we [inaudible] to safety. The point is to keep the safety in the first place. Then, think about what to we really need. Sometimes we don't need vitrectomy. Sometimes we need the scleral buckle. Basically, it's not a matter just of learning vitrectomy, but it's learn what to do, really.