Sophie J. Bakri, M.D., an ophthalmologist and retinal surgeon at Mayo Clinic in Rochester, Minnesota, performs a vitrectomy and membrane peel procedure. Dr. Bakri's patient had an epiretinal membrane in the macula that was visually significant. Watch as Dr. Bakri removes the epiretinal membrane during this procedure at Mayo Clinic. So on this next patient we're going to do an epi retinal membrane peel. I'd like to show you the scam. Um here you can see the macular and here you can see an epi retinal membrane which appears flat. That is causing some traction in the phobia. So we're starting the trek to me. We're doing a 23 gauge to trek to me for a nephew retinal membrane. We're using the avi wide angle lens. I'm starting by cleaning out the sclerotic me. Here, here we go again, lifting the high Lloyd temporarily. You can see the wide edge of the high Lloyd so complete. That attracted me temporarily. Now we're going now into the nasal side and same thing lift up the high Lloyd. Here there we go. I see the edge. So we're all ready to complete the nasal attracted me. So next we're going to do a stain. This is I. C. G. Indo sign in green dye that's diluted with balanced salt solution or injecting it onto the macula. We now put plugs in the I turn off the lights and wait a couple of minutes for the two stain any internal limiting membrane so there's no air and in the eye we removed the plugs and we are going back in now to remove the air and we've actively excluded most of the air. We're letting the rest of the air bubbles come out passively. So when we look at the staining now we can see some positive staining with big that's the internal limiting membrane and we can see negative staining or no staining where the epi retinal membrane is. So don't try to start where the I. L. M. Is and peel that and have the epi retinal membrane come with it here you now see a thick membrane being peeled so the membrane came off the phobia. But now it's a question of getting it off the entire macular. Okay so we have the membrane off now from around the macula and phobia. What we're now going to do is sustain again the membrane which will be the internal limiting membrane underneath the epi retinal membrane. So we're now back to the RV wide angle lens. And here you can see the membrane that has been peeled. So we're now going to air again. We're going to inject the diluted I C. G. We're gonna put plugs in the eye and we're going to wait a couple of minutes for the I. C. G. To stay in the internal limiting membrane animal eject and the rest can come out passively. Yes this is epi retinal membrane you can tell by its consistency. Well that looks like it. You can see the little tiny intra retinal hemorrhages. That's where the epi retinal membrane was. Very adherent to the retina. And so I think we're in great shape here we're all done around the phobia in the macula looks very clean now. So as you can see there's very little vitreous left peripherally. So this is a really good day trek to me. We're now going to close the slot in the site. Yeah.