The ILM should be removed in at least in the fovea and perifoveal area

Remove the EMP and the ILM in one complex

This is difficult if the EMP is too large or thick

Examine the retinal periphery for any iatrogenic breaks and if present, treat them with laser; alternatively, perform prophylactic 360° laser cerclage

Q Fig. 2.9.6 Flowchart: surgical tactics for EMPs

• If the surface of the IOL is dirty because of the settling of inflammatory debris on it, the surface can be cleaned by the Tano membrane scraper.4®

• If there is fluid condensation on the back surface of an IOL4? during BSS-air exchange, dispersive viscoelastic should be injected onto the IOL to coat it and wipe off the condensed fluid.

• Even though the wide angle system is helpful to overcome the visualization difficulties caused by a small pupil, good mydriasis dramatically increases surgical ease. If intracameral adrenaline does not help, iris retractors need to be used.4s

• The use of strong illumination is particularly useful if the media are hazy and/or small gauge vitrectomy is performed/9 The dangers of such a powerful light source must always be kept in mind (see Chap. 3.2).

46 Synergetics, East Windsor Hill, Conn

47 The eye already underwent a posterior capsulectomy.

48 Most iris retractors are made of plastic, not metal. It is not possible to bend them intracamerally. It is therefore crucial to aim well with the paracentesis (using a 27-g needle). The needle should be directed so that it is somewhere between where the pupillary margin is and where it needs to be. Too deep a path makes it very difficult to catch the iris; too shallow a path makes the iris tent. The parallaxis phenomenon must be taken into account when the angle of the needle path is made: objects appear closer to the cornea than they are in reality.

49 e.g., such as provided by the Photon (Synergetics, East Windsor Hill, Conn.)

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