This a case of phakic retinal detachment, we have completed the vitrectomy at this point of time,

putting a PFCL and a fluid gas exchange. And now I'm trying to do a base excision under air, and as you
can see, I'm just excising, and suddenly you see the choroidal port pouting out at this point, but raising
the pressure again it's back. And I'm completing the thing. I'm trying to remove the vitreous and drain
the fluid. And now EFL last part I'm about to drain the last part of the bubble and suddenly you see on
the temporal part. Keep an eye on the temporal part. And you see a choroidal. Now you have choroidals
over there, I've finished up doing minimum lasers, restricted into the just breaks and then pushed under
while and could get out. So that's, what exactly went wrong at this point of time, it's what the house is
open for discussion.

Comments from the panel. So why do you think you got the choroidal detachment?

I think sometimes the cannula, the infusion cannula just in between the surgeries comes off and if
there's already a mild choroidal effusion there that also aggravates it, but at time even with a normal
choroid you could just have the infusion cannula slightly pricking off and creating. That is one of the
likely possibilities.

It was air which was pushing and going inside there at that point of time. And that confirmed it and
suddenly it happened.

So, Prashant why do you think it happened?

That's what I would expect all the panelist to help me out with this. I think there was a it of hypertonic,
it's well established I think now phakic when you're trying to do a peripheral base excision and all.
Specially during fluid gas exchange this choroidal can precipitate. Why? That's a question which.

Did you have valved trocars?

No, it was not valved trocars, we don't use.

Any other comments? Were you doing a procedure while you were under air?

Pardon?

Were you doing a procedure while you were under air when you?

Yeah, I was trying. I had finished off the complete vitreous excision, then I have put a PFCL and then air I
started pushing, at that time we start doing a bit of peripheral vitreous or whatever residual vitreous is
there. At that point I suddenly realized. And then again by increasing the pressure that minimal
choroidal set disappeared. And when I, about to drain the last part of the bubble we could see a big
mount.

So, I think this is a great case of showing one of the advantages of having valved trocars. Because you
know, on their fluid, you know you still maintain the pressure. But when you're under air even with
pressure of 30, even if you go 40, and I think this was a 23 gauge, am I correct?

Exactly.

And that's even, the opening is pretty large so then the eye gets soft. So, the question from the panel,
what do you do different when you get a choroidal detachment. Why Chin, during the case do you do
anything different during surgery you get choroidals, do you do anything different?
So, for this case at the end of the case you probably don't do anything different. You prebaby just carry
on and finish the case. However, if this happened in the middle of the case where you’re still managing
your detachment, then you should it was done already to try to find the reason for the detachment and
for the choroidal to elevate whether it's the pressure or a hemorrhagic one. If it's a hemorrhagic one,
meaning that there's a spontaneous hemorrhage, then you should drain that and deal with that at that
point.

It's one of the things you want to do generally. If you get a choroidal detachment, you're going to be
much quicker in your procedure. You don't want to spend a lot of time; you want to do a lot of
manipulation. And one of the other key points is, you want to make sure the pressure is elevated. So, if
you’re under fluid it happens, higher pressure, make sure the eye does not get soft so that it does not
get any bigger.