Abstract

Dissection of posterior hyaloid and tractional membrane complex (PHTMC) in diabetic vitrectomy is challenging, especially with recurrent bleed causing media haze. A 47-year-old diabetic male underwent vitrectomy for macula involving Tractional Retinal Detachment. Standard 23G core vitrectomy was followed by an “outside-in” approach to make an opening in the mid-peripheral detached vitreous. After partial drainage of subhyaloid hemorrhage (SHH), “premature” fluid-air exchange was done, and the remaining SHH was cleared. This was followed by 360 degree separation of PHTMC from peripheral vitreous using cutter, thereby eliminating anterio-posterior traction. The membrane was then separated from the underlying retina using a pick & removed using cutter. Brilliant blue G assisted internal limiting membrane peeling was done under PFCL. Vitreous base shaving was performed followed by endolaser and silicone oil tamponade.