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Which 20G system is this? DORC? 27G is also from DORC or some other company. A disease such as DR is likely to involve the entire retina, and detaching it would be a bad idea, especially with a cutter. There is greater likelihood of tearing the fragile diabetic retina. Also the value of subfoveal exudates removal doesn't appeal to me because already microscopic changes have taken place in the macula and vision is hardly going to improve substantially to warrant such a drastic surgery. Subfoveal membrane removal was done for AMD but was abandoned for want of this very problem, that we may cosmetically make the macula look good, but does it do any benefit to the patient.

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Which 20G system is this? DORC? 27G is also from DORC or some other company. A disease such as DR is likely to involve the entire retina, and detaching it would be a bad idea, especially with a cutter. There is greater likelihood of tearing the fragile diabetic retina. Also the value of subfoveal exudates removal doesn't appeal to me because already microscopic changes have taken place in the macula and vision is hardly going to improve substantially to warrant such a drastic surgery. Subfoveal membrane removal was done for AMD but was abandoned for want of this very problem, that we may cosmetically make the macula look good, but does it do any benefit to the patient.

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agree with dr. shalabh, is it worth?

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Great job Dr. Labauri, is vision gain may be due to cataract removal?

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Dear Colleagues first of all would like to thank you for your interest and your comments regarding this surgical technique. Instruments used : here I use DORC, 2 step 20G system with valved trocars. Cases like MT, RPE grafts or this one I choose 20 G system because of high fluidic currents and passive aspiration rates, if not take in account some specific instruments which are available only for 20G for such a major surgeries. Technique how to detach retina in this particular cases : 41G subretinal canula connected with VFC system is very good tool to detach the posterior pole and with multiple FGs spread the detachment everywhere as we use it in MT surgery for AMD, but here I do not recommend using 41 Subretinal canula to balloon the posterior pole because it can cause inadvertent tearing the foveal zone or create macular hole (already proved experience during MT surgeries) since in some parts we have strong attachments between RPE and neurosensory retina due to fibroused HA. As you see in video initially I create 2 peripheral retinotomies and then I addressed the macula for membrane peeling with 23G forceps which causes leackage thorugh the port and creates high fluidic currents. In mean while Im removing an epiretinal membrane, RD spreads up to the equator and it is getting ready for large retinotomy. After you perform this latest you give some more minutes and the detachment will reach the macula. Gentle cutter suction can be applied to grasp the retinal edge and elevate without excessive strain step by step. The VA was improved because the foveal zone was freed up from HAs. Here was done clear lens phacoemulsification to shave the vitreous periphery and not the cataract surgery. Predicting the visual prognosis is indeed a difficult job for such patients. IS/OS junctions and ELM has to be assessed by OCT which is not always easy and many speculations will arise during the scan reviewing. FA is mandatory to rule out n existence of macular ischemia. Usually patient needs to be asked when he or she has noted decrease of vision. With these data we can judge whether it is worthy or not to operate this patients. If the process is fresh we can gain some VA due to photoreceptor regeneration, probably by next year we will have enough cases to make some conclusions and present the results in conferences. Thanking you once again for discussion Nikoloz

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Great job Dr.Nikoloz

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