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Hi Somsom: Yes, I exclusively use the BIOM. I peel the ILM in retinal detachment cases if the view permits to prevent the incidence of ERM formation. I consider this on a case by case basis.

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very good

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Outstanding technique. Did you use a BIOM in this case? Your view is excellent, although you still had to use scleral depression. Do you ever remove the ILM in these cases to ensure no erm development postop?

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Hi Asallam: You are absolutely correct. The retina surgeon's job is to close the break and then you can allow the RPE to do what it does best-- remove subretinal fluid. I don't get nervous if there is a little SRF remaining at the end of the case as I know that if the break is closed, the fluid will be gone by the next day. With modern day vitrectomy, it is so easy to have the retina flat by the end of the case. So while I am in the eye I like to leave the retina flat if I can. However, this is not always necessary as you pointed out.

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Ahmed Sallam, Retina fellow, UK. Hi. Excellent video. Very educative indeed. I think with a superior break you do not really need to get the retina 100% flat on table, so in many time you can only drain through the anterior break. As long as you get all traction removed and the gas bubble will close the break then fluid should all be absorbed. The trick for preventing fluid going back towards the posterior pole is not to drain much over the optic disk as long as you draining through anterior break. Sometimes if I think that gas bubble is not gonna be big, I'd use a slightly expansile gas like 30% SF6. I think of Retinal detachemt surgery as a retinal break rather than a retinal detachement surgery ie same priniciple of non drainge buckle surgery- just close the break. What do you think? Thank you for your time.

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Hi Sabrosa: Posterior drainage retinotomy was used as the tear was very anterior and shallow subretinal fluid was present even after fluid-fluid exchange (and probably after air-fluid exchange). Since fovea was attached, going to air without a posterior drainage retinotomy would have caused SRF to settle posteriorly and possibly detach the fovea. Alternatively, one could use PFO in this situation. This case could have been performed without 360 laser, however, in pseudophakic cases I typically do 360 laser to treat the possibility of an occult micro-break. One could use air or SF6 as an alternative to C3F8 in cases similar to this one. Lastly, diathermy was used to marked the HST just prior to the creation of the posterior drainage retinotomy (not shown in video). All very good comments.

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Few comments:

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