Methods:

23g valved trocars, no chandelier lights. Core vitrectomy, creation of PVD using Triamcinolone. Vitrectomy in medium periphery, ERM peeling without dyes, ILM peeling till vascular arcades using Infracyanine dye for 30 sec, confirmation of complete peeling using a second and eventual third dying with Infracyanine. Complete peripheral vitrectomy using Triamcinolone with particular attention at the sclerotomy sites. The peripheral vitrectomy is done through the panoramic lens with the help of external indentation by an assistant or under direct visualization through the microscope and external indentation by the surgeon. Check with the panoramic view and the light for peripheral breaks or rhegmatogenous lesions and final laser treatment at identified lesions. BSS-air exchange.Drainage of the remaining fluid after waiting at least 5 minutes.Removal of the superior trocars.Injection of 0.8 ml SF6 through the infusion cannula with a 30 G needle.Subconjunctival injection of 1 ml of Betamethasone.

Advantages:

1.Staining: to verify the complete peeling of the ILM. Infracyanine dye often dyes ILM better than other dyes in our experience.

2. Waiting 5 minutes after the BSS-air exchange. At the end of the BSS-air exchange there is still liquid in the peripheral retina and it takes time to come down. Removing this fluid is important in the closure of the hole.

3. Using Sf6 and 3 days positioning will help close and keep the hole closed while the retinal edges of the hole seal each other.

4. Peripheral vitrectomy and attention to avoid vitreous incarceration through the sclerotomies reduce the risk of secondary retinal detachment. Peripheral retinal check at the end of vitrectomy helps in identifying rhegmatogenous lesions.

5. The avoidance of chandelier lights reduces the costs of the procedure.

6. The use of Triamcinolone helps PVD and peripheral vitrectomy

7. Subconjunctival steroids reduce the risk of postoperative inflammation and secondary cystoid macular edema.

Effectiveness:

13 patients have been treated and we achieved 100% closure, no postoperative complication during the follow up.