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When Injecting Air Practice (and Patience) Make Perfect

In a patient with macular degeneration and a large submacular hemorrhage Jay G. Prensky, MD, describes his steps after performing a standard 25-gauge vitrectomy. He injects tissue plasminogen activator (tPA) subretinally through a 41-gauge cannula at 6 mm hg to create a large bleb. He then injects air to further dissect the blood from the retina and to displace the hemorrhage even more. Next, Dr. Prensky performs a fluid-air exchange. A couple of days after the gas bubble receded there was almost complete displacement of the subretinal hemorrhage. Dr. Prensky’s takeaway message? Inject enough volume until you see an adequate bleb to accomplish the goal you desire in each individual patient.

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