Overlooked epiretinal membrane
Drainage of subretinal fluid with fluid-air exchange might also reveal an overlooked epiretinal membrane, which should be peeled under air with an ILM forceps. If the retina still does not attach, surgeons should look again for a subretinal band and perform punch-through retinotomy with an end-grasping forceps as needed.
Retinectomy-under-air is performed only if the retina remains detached after all measures have been taken. It is done in an incremental fashion to remove only the amount of tissue that is necessary to reattach the retina. If, however, the retinectomy reaches 270°, it should be extended to 360° because the remaining quadrant will contract postoperatively, Dr. Charles said.
If bleeding occurs, surgeons should raise the pressure and apply confluent laser to severed large vessels. Confluent laser, not spots, is also applied to the retinectomy edge. Once hemostasis is achieved, the pressure can be lowered and air-silicone exchange can be done.