Ps

All necessary and possible steps must be taken to AS

achieve retinal attachment, including silicone oil tamponade. Freeing the ciliary body from membranes and reattaching it if it is detached are crucial. If silicone oil is injected,5 this should be done either at the conclusion of vitrectomy once the AC has been filled with viscoelastics6, or the BSS-air-silicone oil exchanges are performed after the corneal graft is in place. In either case, the sclerotomies are only plugged, not sutured, and the infusion cannula also remains in place

5 Which is the vast majority of the cases

6 The AS is asked not to irrigate in the AC with BSS after this point.

Vitreoretinal surgery (see Chaps. 2.4-2.9 and 2.10-2.14 for details)

Table 2.15.3 (continued) A brief overview of the surgical steps during TKP vitrectomy

Procedure

Comment

Surgeon"

Removal of the TKP and completing reconstruction of the anterior segment

The sutures are cut, the AC is rechecked for depth, fresh bleeding, fibrinous membranes, etc. An IOL may be implanted in those exceptional cases when the retina was not detached and silicone oil is not injected. If silicone oil is used, the viscoelastics should be either left behind7 or replaced with air, not BSS.8 The iris diaphragm should be reconstituted if the pupil is mydriatic and sufficient amount of the iris is left. If the iris needs to be sutured, the pupil must not be made too small so that it does not interfere with postoperative inspection of the retina or hinder any future posterior segment surgery

AS or PS

Grafting

The standard PK rules are followed. The graft diameter should be 0.5 or 0.75 mm larger than the trephined button's diameter

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