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ANDREW BARKMEIER: So here we're making our incision, 30 degree angle to the sclera. So we're cautiously going to the central vitreous. We can see that there's some dehemoglobinized hemorrhage. We scrutinized the B-scan ultrasound beforehand, and there's an area of traction visible at about 2 o'clock anteriorly.

So now we'll slowly go around 360 degrees counterclockwise. And now we've separated all of the vitreoretinal traction there. So at this point we're moving the infusion to direct it posteriorly. Basically, we want to finish our peripheral vitrectomy, and then I'll probably go down with a soft tip to remove it. And then we'll be able to see if it's actively bleeding.

So at this point we are shaving the peripheral vitreous skirt. We're rotating the eye far in the direction that we're working. So we can see here that we have an avulsed vessel. That is tearing and cheese wiring of the vessel. It's caused probably the majority of this bleeding, leaving a tear here that we'll need to surround.

So now we'll address this area of interest here. I want to see where the tear is extended. Let me just amputate this area actually.

So at this point we're using scleral depression to shave the vitreous space for two primary goals. One is to improve our view to become confident that we've excluded any potential retinal tears. And number two is there's less hemorrhage remaining in the eye that will enter the vitreous cavity postoperatively and blur his vision.

Now we'll just perform some endolaser surrounding the break. So at this point we'll remove the ports, and we'll have a very low threshold to suturing the ports. Any time there's a vascular issue where hemorrhage is possible, you want to reduce the risk of hypotony, causing vitreous hemorrhage postoperatively.

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