Some cases of retinal detachment particualry in young phakic patients, may not have posterior vitreous detachment (PVD). If operated by PPV, induction of PVD in these cases is mandatory. However, PVD induction by active aspiration of the vitreous cortex over the optic disc margin as usually employed in PPV surgery can be challenging in these eyes because of firmly adherent posterior hyaloid and the absence of counter traction from the retina. Modern small 25 gauge vitrectomy cutters have reduced grasping power as compared to 20 or 23 gauge cutters, thereby rendering PVD induction even more difficult. Several maneuvers have been described for induction of PVD in eyes with a firmly adherent posterior hyaloid including; active aspiration with a silicone-tipped cannula, inducing a break using a diamond duster or using a sharp pick or barbed micro-vitreoretinal blade. Herein, we describe a modified technique for creating a PVD using a micropick angled 45° from the tip connected to controlled active aspiration.

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Abdallah A Ellabban