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    Multilayered Vitreoschisis in Diabetic Vitrectomy: Scan and Plan

    AAO 2023 Video Program
    Diagnostic & Imaging , Retina/Vitreous

    Diabetic membrane dissection is simple if we are in the correct plane and unforgiving if we are not. Detailed preoperative swept source optical coherence tomography (SS-OCT) assessment of the vitreoretinal interface helps in identifying the correct surgical plane, making surgery safe and easy. Usually, vitreoschisis has two leaves: an anterior leaf, which is the pseudoplane, and a posterior leaf, which is the correct plane for dissection. Multilayered vitreoschisis is a pattern imaged on SS-OCT overlying areas of tractional retinal detachment (TRD), wherein there is a honeycomb pattern between the multiple layers of cortical vitreous. To get to the correct plane in these cases is challenging. This video depicts a safe technique for tackling such cases. The hyaloid is lifted from the disc and then extended circumferentially to isolate the membrane over the TRD. The membrane in cases with multilayered vitreoschisis is thick, opaque and difficult to hold. Isolating the membrane helps in visualizing the attachments for bimanual dissection. Detailed OCT analysis also helps to plan additional macular maneuvers.