3.2Patient Selection

Before performing pars plana vitrectomies without supervision, the beginner should learn the techniques of pars plana vitrectomy (PPV) step by step. Most routine surgeries are suitable, in particular in pseudophakic eyes, silicone oil removals or eyes with vitreous haemorrhage and an attached retina.

3.3Recommended Learning Steps for Beginners

We recommend the beginner to train the following steps (the steps can be practised separately):

1. Insertion and removal of trocars and suturing of sclerotomies. We recommend that the conjunctiva be opened before suturing the sclerotomy.

2. Use of the light pipe and focussing the image with the BIOM.

3. Staining of the vitreous (for example, with triamcinolone) and core vitrectomy. 4. Induction of posterior vitreous detachment.

5. Trimming of the vitreous base with bimanual technique (chandelier light).

6.Peeling of an epiretinal membrane.

You can then perform the first surgeries from beginning to end. The following

pathologies may be appropriate (with rising difficulty level).

Easy – more advanced surgeries

1. Silicone oil removal with passive and active aspiration with use of the BIOM 2. PPV in diabetic retinopathy with vitreous haemorrhage without tractional retinal

detachment and PRP

3.ERM removal

4.ILM peeling

5.Dislocated IOL (sclerafixation of IOL)

6.Dislocated (hard) nucleus

3.4Complicated Surgeries for Advanced Surgeons

The following surgeries are hard nuts, which can be cracked with a little training. All surgeries demand a thorough and correct preoperative assessment. Draw up a plan on how you wish to proceed intraoperatively. An advanced proliferative diabetic retinopathy with tractional detachment can be very difficult to handle. A PVR detachment is technically challenging and demanding. Last but not least, the subchoroidal haemorrhage is an especially difficult surgery. You can be proud of yourself if you can manage this pathology.