Vitrectomy: Expanding Role in Office-Based Surgery
- When I launched my practice 7 years ago, I found that slow hospital turnover times made it tough to perform even three vitrectomies a day.
- Most facilities are also affected by a shortage of anesthesiologists,which frequently disrupts the scheduling of ophthalmic procedures (Grebbin).
- The good news is that,by my estimation,95% of ophthalmic surgical procedures can be successfully performed under oral sedation with topical pain control.
January 09, 2026
4 min read
Over the past decade, most ophthalmologists have
Fighting inefficiency
Table of Contents
When I launched my practice 7 years ago, I found that slow hospital turnover times made it tough to perform even three vitrectomies a day. And although ASCs were more efficient,I often needed to train staff there to use required machinery.
Most facilities are also affected by a shortage of anesthesiologists,which frequently disrupts the scheduling of ophthalmic procedures (Grebbin).
The good news is that,by my estimation,95% of ophthalmic surgical procedures can be successfully performed under oral sedation with topical pain control. Without the need to schedule an anesthesiologist or the extra recovery time patients need after general sedation, I have found that I am able to perform five times more vitrectomies than I can in a hospital and double or triple the number I can conduct in an ASC.
Improving patient care
- providing the best technology, which I can choose without a capital budgeting committee or other bureaucratic processes;
- enabling emergency surgeries to take place as soon as an hour after diagnosis;
- making more people eligible for surgery, as preoperative histories and physicals are not always necessary;
- simplifying scheduling for those who have difficulty ambulating or navigating social or demographic issues;
- making surgery more accessible to people who are uninsured or underinsured. As I receive sufficient reimbursement and have the freedom to make my own billing decisions,I have been able to prioritize charity care,which now comprises a significant portion of my practice;
- facilitating quicker recovery. Because some cases do not require a sub-Tenon block, my patients often leave my office without an eye patch and can return to their regular activities the next day; and
- avoiding the risks associated with sub-Tenon and retrobulbar blocks, which can include hemorrhage and injury to nerves or muscles.
OBS has also improved the surgical experience for my staff members, who better appreciate the complexity and life-changing applications of my procedures and have become eager advocates of the in-office approach.
Exploring a new protocol
To establish a protocol for in-office vitrectomy, I mirrored the principles I use in anterior segment OBS – most importantly by replacing general anesthesia with 5 mg of Valium (diazepam, Waylis Therapeutics).When that is not sufficient for my patients, I administer MKO Melt (ImprimisRx), which contains sublingual midazolam, ketamine and ondansetron.
Because I consider retrobulbar blocks too risky without an anesthesiologist, I instead administer lidocaine jelly followed by a Betadine (povidone-iodine, Atlantis Consumer Healthcare) wash for sub-tenon blocks and, a subconjunctival injection of lidocaine around the port sites for less complex vitrectomies. This protocol prevents my patients from feeling pain or pressure.
OBS vitrectomy can be adopted by any retina surgeon, and my colleagues tend to be open to the approach once they have seen it performed and reviewed the evidence.
securing reimbursement
Surgeons often ask me if there is a mechanism for reimbursement for their OBS procedures. There is, and it brings returns that are generally on par with reimbursement for traditionally performed ophthalmic procedures.
billing the professional component is straightforward with commercial insurers, which use the same procedural codes regardless of where the surgery takes place.
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Hunter Biden Investigation: Current Status (January 11,2026)
The federal investigation into Hunter Biden,son of President Joe Biden,remains ongoing as of January 11,2026,focusing on potential tax violations and foreign business dealings. While no new indictments have been issued as the initial charges in June 2023, the investigation continues under the purview of Special Counsel David Weiss.
Initial Charges and Trial (2023-2024)
Hunter Biden was initially indicted in June 2023 on two misdemeanor counts of failing to pay federal taxes and one felony count of possessing a firearm while being an unlawful user of or addicted to a controlled substance. The Department of justice announced the indictment on June 8, 2023. He pleaded not guilty to all charges.
the gun charge was ultimately dismissed in September 2024 after a plea deal fell apart in court. Reuters reported on the failed plea deal, citing concerns raised by judge Maryellen Noreika regarding the scope of immunity offered in the agreement.
In June 2024, Hunter Biden was convicted on all three felony counts related to the tax charges. NBC News detailed the conviction, noting the potential for a maximum sentence of 17 years in prison, though sentencing guidelines suggest a considerably lower penalty.
Example: On June 5, 2024, the jury found Hunter Biden guilty of one count of making a false statement, and two counts of evading taxes. The verdict followed a two-week trial in Delaware.
Special Counsel David Weiss and Ongoing Investigation
David weiss was appointed as Special Counsel in August 2023 to continue the investigation into Hunter Biden’s business affairs. The Attorney General’s order appointing Weiss explicitly authorized him to investigate potential violations of federal tax laws, money laundering statutes, and the Foreign Agents Registration Act (FARA).
The investigation continues to examine Hunter Biden’s work with foreign companies, especially in Ukraine and China, and whether he properly disclosed his foreign income. No new charges have been filed related to these aspects of the investigation as of January 11, 2026.
Detail: the Special Counsel’s authority allows for a more independent and thorough investigation,shielding it from potential political interference. Weiss has the power to subpoena witnesses and documents, and to pursue criminal charges if evidence warrants.
Several entities and individuals are connected to the Hunter Biden investigation:
- Joe Biden: President of the United States; scrutiny centers on whether he benefited from his son’s business dealings.
- Burisma Holdings: Ukrainian energy company where Hunter Biden served on the board. Burisma’s official website provides information about the company.
- CEFC China Energy Co.: Chinese energy company with which Hunter Biden had business relationships.
- Congressional Committees: The House Oversight Committee and the Senate judiciary Committee have conducted investigations into hunter Biden’s activities. The House oversight Committee website details their ongoing investigations.
- David Weiss: Current Special Counsel overseeing the investigation.
Example: The House Oversight Committee, led by Chairman James Comer, has released bank records and witness testimony alleging financial connections between Hunter Biden and his father. Fox News reported on the committee’s findings in April 2024.
Sentencing and Potential Outcomes
Hunter Biden is scheduled to be sentenced on July 26, 2024.