Middle segment surgery: indications, techniques, and future directions

Middle segment surgery (MSS) refers to ophthalmic surgical intervention through the pars plana to prevent or manage anterior segment abnormality and surgical challenges/complications. It has gained interest in recent years due to its expanding indications and utility across ophthalmic subspecialties. Although MSS has been employed for decades, its integration into contemporary ophthalmic surgery requires a multidisciplinary understanding of both anterior and posterior segment diagnostics, treatment options and surgical techniques.

Although the nomenclature MSS may be relatively new, there is significant evidence in the literature that the intervention of choice to resolve anterior segment, especially lens-related, abnormality and postoperative surgical complications may be best offered not only through the limbus but also through the pars plana. The surgeon may have training in anterior or posterior segment techniques. Cross training may be ideal in this setting.

This article reviews foundational skills necessary for MSS, outlines current clinical indications, and proposes pathways for training, credentialing, and future innovation.