D i.e. Exophotocoagulation Treatment of advanced proliferative diabetic retinopathy with vitreoretinal fibrosis and tractional rectinal detachment involves previtrectomy pan retinal endophoto coagulation (not exophotocoagulation)Q, vitrectomy (pars plana or posterior route), reattachment of detached or torn retina and removal of epiretinal membraneQ. In most cases it is preferable to attempt panretinal photocoagulation, because the more laser a patient has previtrectomy the better he or she usually does after vitrectomy. An uncommon and unfounate complication of panretinal photocoagulation, paicularly in patients with vitreous hemorrhage & preexisting fibrosis, is acceleration or production of a tractional detachment by the laser treatment. Vitrectomy removes the scaffolding & possible stimuli (disintegrated blood products) for neovascular growth. Endophotocoagulation is used exclusively during a vitrectomy procedureQ. The endophotocoagulation probe may have a laser fiber +- an aspirating po to help remove subretinal fluid. To best treat retinal tears by endophotocoagulation, it is impoant that all subretinal fluids be removed from under the retina for the laser to take. If all traction is removed from the tear, once the fluid is removed from under the retina, it usually does not accumulate. Epiretinal membrane is a thin sheet of abnormal scar tissue that grows over the retina and causes distoion of vision due to macular puckering (s/t contracted epiretinal membrane), detachment (secondary to localized retinal traction) and opacification of membrane.