Gas tamponade in aphakia: How do you keep it out of the AC? Face down posture? Any other recommendations?

You can inject an air bubble into the anterior chamber and constrict the pupil with pilocarpine drops. Face down posture for 1 week.

Phakic patient with sutured 20G pars plana infusion (inferotemporal quadrant) that is blocked with ciliary epithelium: How do you clear the tissue covering the tip? Would you use the cutter or the MVR blade entering from the same side sclerotomy, i.e. the superotemporal one in order to avoid the lens?

I use the spatula from the other side. If you work in a phakic eye, it is difficult. Question: Why is the trocar covered by epithelium? Choroidal detachment? Did the infusion trocar go out under the operation and you got a choroidal detachment? If the latter is the case, I recommend following trick: Remove the infusion trocar, replace the infusion to an instrument trocar, increase the infusion, take a trauma trocar from Alcon (23G, 6 mm long) and use this as a new infusion trocar, and set the infusion back. You will have no problems with the epithelium.

During removal of the last trocar in a gas-filled eye, the eye becomes extremely decompressed and soft. A suture is placed to the sclerotomy and the eye is filled again with gas through a 30G needle. Any useful tips?

You will not have this problem with 25G and not all with 27G. You have this problem with 23G. And the reason is the bigger sclerotomy. It is therefore important to insert the trocar in a 15° angle before operation. After operation compress the sclerotomy with an anatomic forceps or scleral depressor; if it leaks, make a suture. Remove first both instrument trocars. If the eye is soft, add more gas and remove as last manoeuvre the infusion trocar, but remove first the infusion and then the trocar.

If the eye is still soft, your idea with the postoperative injection is excellent.

Could the 23G cutter be used during fluid–air exchange to aspirate the subretinal fluid (active aspiration mode) instead of a 23G backflush cannula (passive aspiration)?

Yes of course. Even better (easier to manoeuvre) is a flute needle with active aspiration.

When injecting PFCL, do you reduce the infusion pressure or not?

No. I work bimanual. One hand injects PFCL and the other hand aspirates BSS with the flute needle. This works only if you use a chandelier light. If you do not have/use a chandelier light, I recommend a double-barrelled infusion cannula (see Chap. 28 in my book).

Any tips on avoiding slippage during PFCL–silicone oil exchange?

The danger of slippage from PFCL to silicone oil is low. The danger of slippage is high from PFCL to air to gas and especially if it is a giant tear. Look in the book: Retinectomy. The essential surgical step is to aspirate the PFCL until it is just posterior to the edge of the giant tear (posterior edge of the tear). Now aspirate thoroughly the residual subretinal fluid from the tear. Only when the tear is completely dry you can continue with aspiration of PFCL.