**4.3 Vitreoschisis or second membrane identification**

Often the posterior vitreous gel splits into an anterior and a posterior leaflet [22]. One may be easily mistaken by looking at the posterior leaflet as the edge of the hyaloid near the FVP and start pulling it. It is important to identify the anterior leaflet that extends beyond the FVP sometimes as thin flimsy glistening membrane onto the surface of TRD/adjacent retina and start separating it from the retina. Once this is identified using a pic or a needle and separated, it is easier to get the right plane for further dissection. If not correctly identified, one can have multiple iatrogenic breaks, since the anterior leaflet of posterior hyaloid (also known as second membrane) is still adherent to underlying retina. Though the aetiology is uncertain, some authors believe that the split may be caused due to the bleeding from the vascular epicentres (Video 3; https:// cdn.intechopen.com/public/chapter\_videos/241965/VIDEO\_3.mov).

In rare circumstances, where the hyaloid is very densely adherent extending till periphery, with flat broad and dense fibrovascular proliferations, one of the authors (Dr. MPS) have tried intravitreal autologous serum injection 24 hours prior to the surgery for induction of PVD with a successful outcome. In the event of any iatrogenic break in the periphery or near the vitreous base better, one can also support with BB/SB to avoid transmitted tractions from the vitreous base.

Hybrid vitrectomy: Some surgeons prefer hybrid vitrectomy using 23G trocar cannulas and 25G or 27G cutters for better membrane delamination. This has the advantage of higher cut-rate and the port site being closer to the tip of cutter helps in easier grasp of membranes [23]. Newer cutters (27G) with very high cutting rates with low vaccum can allow precise cutting in close proximity to the retina with reduced risk of breaks [24].
