• viscosurgery
• diabetic

Grigorian and colleagues recently recounted their experience of using viscosurgery to remove epiretinal membranes (ERMs) from eyes with proliferative diabetic retinopathy (PDR).¹ They concluded that “viscodissection” (injection of Healon between the fibrovascular proliferations and the retina) is safe and is equally as effective as its non-use. On the contrary, their study shows that viscodissection is not cost effective (because of the costs of both the viscoelastic and the extra operating time), and confirms that the technique is inherently unsafe in PDR.^2,3

The use of Healon to aid dissection of fibroglial and fibrovascular ERMs during vitrectomy was introduced in the 1980s⁴ but was not widely adopted. Viscoelastic material squirting out from under the ERMs was “messy” and led to the formulation (in the 1990s) of yellow tinted Healon to aid its visualisation and simplify its removal⁵ and then Healon GV (viscosity 10 times that of Healon) for adherent diabetic ERMs.⁶ In 1984, we began undertaking “viscodelamination” in diabetic vitrectomy.^2, …