•To operate a forceps that needs to execute fine maneuvers, it must be held securely (see above) and break down the apparently single action into several independent movements8:

–Moving over the target tissue.

–Partially closing the jaws to reduce the distance they must travel before they are closed on the target tissue.

–Lowering the jaws to the plane of the target tissue.

–Pressing down into the target tissue.

–Closing the jaws while remaining in the same plane.9

–Elevating the jaws, with the grabbed material securely held onto, slightly above the tissue plane to patiently wait until the tissue rips.

–Moving the grabbed, now torn tissue along a preplanned path.

20.3Injecting into the Vitreous Cavity During Surgery

Regardless of the material being injected, the use of the palm, rather than the index finger, to push on the plunger reduces the risk of retinal injury (see Sect. 34.3.2 and

Fig. 34.5b).

8In this case grabbing the ILM that has not been incised before (blunt opening, see Sect. 32.1.2.2).

9The inexperienced surgeon tends to lift the forceps before or as the jaws are closing; consequently there is no purchase of the membrane. This, of course, is less of an error than closing it while the jaws are pushed down.