This is a patient of PDL cases, I'm removing a protective membrane with a 25-gauge end cutter.

And
then I routinely peel interim membrane and completely remove of operative [00:00:25.11] but I am
adhered strongly the retinal surface and the Swedish system. So, one possibility resulting in retinal tear,
I was so upset at that time. But I got myself and again then I stained it and internal rim membrane with
HCG and peeled internal rim membrane allowing the retinal tears to avoid post opera tip and for
[00:01:00.04] resulting in retinal detachment. I think this is a very severe case.

Comments from the panel?

I think this is what happens mark when you have very high magnification. And sometimes we lose what
we're doing in the periphery. It has a double edge. Of course, NGenuity gives a beautiful view of the
macula surgeries, but as we turn on while testing, I see most of my fellows, they ty to hit the retina. Of
course, I have been taught when doing my fellowship is always lift, lift, lift when you're trying to peel it.
Too high magnification might probably cause such problems.

I think the peeling component comes to an effect when you’re operating in high myopes, I know that the
population of high myopia is quite high in this area. But I think the key point was what you said at the
beginning here when you get to the edge of the lamp when you’re not centered, then it becomes
difficult. Number one, you get the prismatic effect of the length so you lose your depth perception, btu
you want to finish it up. And at that point your brain is not really thinking that you're not centered. And I
think that's what eds up happening. The peeling component that usually do that if I work, I'm peeling on
very high myopes where you have a staphyloma, what ends up happening is if you peel parallel to the
surface of the retina, you’re going to hit the wall of the staphyloma and then you’re going to get
bleeding. But in a regular peeling usually you don't lift, so you peel on the surface but the key is, this is
something you need to always think about, always recenter recenter, recenter, when you’re getting
towards the edge, make sure that you’re always centered. That decreases the likelihood of this
happening. Now the key point is many times because we all keep pointing out, you do not need to do
laser treatment, they do it fine and the key is usually, and the patient's fine as long as it's usually
peripheral it's not in the macula or the center of the fovea. But the key is when you get bleeding the first
thing you want to do is to go up on the pressure. You know you get all rattled that this happened but
before you start thinking the only thing that can cause a harm if you get subretinal and sub-macular
hemorrhage. That can impact the vision. So, the first thing you want to do is go up on the pressure.
Bleeding on the retina, on the surface vitreous doesn't really matter. And that gives you time to think
what am I going to do and luckily you didn't have any bleeding Kazuaki but then the rest is try to relieve
as much traction as you can. If it's difficult, leave it alone. You don't want to make it larger. And then
usually putting a glass bubble and positioning and the patient usually does fine.