Forceps: vertical action
These forceps6 have platforms that are horizontal; the lower blade can slide under the ILM, grasp is accomplished by the upper blade being lowered onto the ILM/lower blade platform. These forceps are most useful when the ILM is not very adherent; they should not be employed, however, if the retina is not healthy (e.g., CME is present)
These forceps have vertically positioned platforms, which grab the tissue simultaneously from two sides. By definition they must be pressed down during the initial grab7 and even later if the ILM tears so that the remaining edge is still adherent to the retina. There are two basic designs: one with a large platform,8 which allows relatively easy initial grasp because the ILM tends to "rise up" in front of the forceps that pushes the retina down; the grasp remains firm throughout the peeling and the ILM's tendency to tear is reduced because its contact area with the forceps is large. The disadvantage of these forceps is the loss of visual control of maneuvers performed on the retinal surface. The second design9 has the great advantage of coming down to the retina at an angle and its shafts are hollowed, which allow continual observation of all maneuvers: the shaft or the platforms never block the surgeon's view. The disadvantages of these forceps are the relatively small size of the platform (i.e., tearing of the ILM is more common) and the vulnerability of the instrument
Spatula Rarely used today; it was originally conceived as a device that bluntly dissects and separates the ILM from the retina
FILMS This is the most physiological and least traumatic method : the
ILM is separated by viscoelastic fluid gently injected underneath from a specially designed cannula. It is the only method where the retina is not elevated but actually gets pushed down while the separation occurs. Once the ILM is lifted, it is removed with any type of forceps. The FILMS technique should not be employed in eyes with unhealthy macula (e.g., CME)
5 Similarly to a cataract surgeon using a sharp, pointed instrument to perform capsulorhexis. The ILM must also be flipped as it is being dialed around.
6 e.g., Storz #E 1964 (Bausch and Lomb, St. Louis, Mo.)
7 Ideally, the two actions: pressing down onto the retina and grabbing the ILM are separated in time, not done simultaneously.
8 e.g., DORC #1286 (Zuidland, The Netherlands)
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