Approach to Diabetic Epimacular membranes in Diabetic macular Edema surgery Risk of Diabetic Epimacular membranes (ERM) Peeling: These membranes are rather toughly adherent to an underlying fragile ischemic macula. Vascular connections may be present, in or around, the area of the membranes.

This may elicit: iatrogenic retinal breaks, uncontrolled retinal bleeding.

My Technique: I use Chandelier as the illumination tool, and an aspheric macula biconcave contact lens as the viewing tool. I start the ILM peeling by, stroking the macular surface with the closed tip of the end gripping forceps. I perform the ERM peeling in a Peel and Stop fashion. This is done in a slow dexterous pattern. Bimanual Peeling and Dissection are sometimes needed, especially in recurrent epimacular proliferations. This is done by using the forceps in one hand and a fashioned Pick or cutting probe in the other hand.

Advantages: Chandelier allows better employment of the second hand: either in bimanual surgery, or as a self-stabilizing element for the main working hand.

This allows for a slow stable dexterous ERM Peel. This eliminates the risk of breaks, and uncontrolled haemorrhage. Aspheric contact lens enables spectacular stereopsis and high resolution.

Disadvantage: There is a relatively dim illumination with chandelier. However, adaptation is possible. There is a limited field of view with some ERMs. However, this can be overcome by either contact lens Tilt or using BIOM to complete the peeling of large extensive membranes.

Contact Details:

Cell Phone: +201223638643

Wael Ewais