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June 1988

Scleral Depression to Facilitate Endophotocoagulation

Arch Ophthalmol. 1988;106(6):721. doi:10.1001/archopht.1988.01060130791011

To the Editor.  —The beneficial effects of intraoperative endophotocoagulation as an adjunct to trans pars plana vitrectomy surgery for diabetic retinal detachments and proliferative vitreoretinopathy have been well established.1 However, even after anteroposterior traction has been relieved, it is often difficult to achieve adequate photocoagulation of various sections of the retina. This may variably be due to residual elevation of the retina with subretinal fluid or excessive swelling of normally apposed retina secondary to intraretinal edema.It has been our observation that the application of endophotocoagulation is facilitated when the surgical assistant performs scleral depression of the peripheral and midperipheral retina while photocoagulation is applied by the surgeon. This appears to act as a "press" and forces intraretinal fluid away from the site of photocoagulation. Similarly, scleral depression brings elevated retina into closer apposition with the retinal pigment epithelium when there is residual subretinal fluid. In this manner, thorough

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