The following transcript has been edited for clarity:

Hi, I’m Dr. Diana Do of Retinal Physician, and I'm with Maria Barrocal, MD. Thank you for sharing all your great surgical cases today at the American Society of Retina Specialists (ASRS) meeting. Can you give us some basic tips when you’re encountering those difficult-to-treat tractional retinal detachments?

Dr. Berrocal: Yes, the way I approach a difficult traction retinal detachment is, when I see a patient and they haven’t had any laser, I laser the periphery before I do surgery. I don’t routinely inject anti-VEGFs for a number of reasons: One, because many of those patients do not come for surgery or they do not pass clearance and then they can develop branch [neovascularization] and get a worsening detachment. But also, because the anti-VEGF increase the fibrosis a little bit, so it can make some of the dissection harder. With the new machines we can really be good at controlling bleeding and controlling pressure. So, I do that. Then I really look at the eye and I determine what needs to be done, because in traction detachments you don’t really have to remove everything. You have to just liberate the traction and the posterior pole and all the attachments of the vitreous to areas of fibrovascular tissue. So, you do that, and then laser well. The main point is not to create iatrogenic breaks, because once you create an iatrogenic break the chances of that eye going downhill increase significantly.

Dr. Do: Thank you so much for those tips; it’s great to have you!

Dr. Berrocal: Yes, thank you for having me. RP