Visibility and Vitreoretinal Surgery

Detailed discussion of this topic is beyond the scope of this book; only a few helpful suggestions are made here:

• Use a wide-angle viewing system. Conditions45 that would otherwise make surgery much more difficult if not impossible lose at least some of their importance if a panoramic viewing system is used.

• Corneal edema is very common after corneal trauma and can be exacerbated by scleral indentation. The edema may be epithelial or stromal.

- Scraping of the epithelium can dramatically improve visibility; however, it increases the postoperative edema and infection risk, and healing may be protracted and painful, especially in diabetics.

- Alternatives to scraping include topical glucose (40%) and glycerin (50-95%). The solutions are applied by soaking a small piece of cotton, which is the placed on the cornea for a few minutes.

- If Descemet's membrane is folded, the AC can be pressurized with viscoelastics. Filling the AC with viscoelastic is also helpful if BSS-fluid exchange or silicone oil implantation is performed in an eye that is pseudophakic or has weak zonules.

45 i.e., corneal edema, small pupil, lens opacity

Incise the EMP with a barbed MVR blade

Incise the EMP with a barbed MVR blade

Make sure that all layers of the EMP are cut, not just the most superficial layer

Grab the EMP with a forceps that has a rather large platform

Make sure that all layers of the EMP are cut, not just the most superficial layer

Remove the EMP and the ILM in one complex

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