The surgical techniques is as follows:
• If possible, general anesthesia should be used, although even topical anesthesia (see Chap. 1.8) is an alternative if necessary .
• The first task is to open the conjunctiva anteriorly and establish a clean surgical field.
• Judicious diathermy must be applied to stop any bleeding.
• An orbital retractor may have to carefully be inserted to keep subconjunctival tissues and orbital fat out.7
7 This author prefers to insert and position the retractor himself and then hand it over to the nurse.
• The use of traction sutures (see Chap. 2.12) offers advantages but also raises certain risks if too much tension is put on them.
• The episcleral tissue, especially if vitreous prolapse is also present, may be difficult to separate from the sclera. Pressure must never be exerted onto the globe; it is an individual decision whether a sharp instrument or a blunt spatula with proper counterforce8 is used. A blunt-tipped scissor provides both, allowing blunt tissue separation as well as cutting as necessary.
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