Scleral indentation is a step of great importance during vitreoretinal surgeries. It can be done by self-indentation while using a chandelier endo-illumination. Alternatively, it can be done by the assistant while the surgeon is holding an endo-illumination light probe. However, this requires a skilled assistant and good coordination with the surgeon.

The use of an endo-illumination light probe has several advantages over chandelier endo-illumination. It allows the use of variable illumination techniques including direct illumination, specular illumination causing transparent surfaces to glow where light is shone at a critical angle, or retro-illumination [12].

In addition, the 23 gauge endo-illumination probe would give a brighter illumination compared to the 25-gauge endoilluminator due to better light transmission and larger surface area of the fiber optic [12].

Moreover, the chandelier endo-illumination gives a fixed more distant illumination which makes it more difficult to identify the dissection planes and to see transparent structures such as the vitreous or the epiretinal membranes (ERM), and may cause more glare after fluid-air exchange compared to focal illumination from light probes [12].

Finally, the heat buildup may occur in the steadily illuminated chandelier [13] and Shadows of the instruments crossing the path of the light may worsen the view.

Several types of chandelier illumination are available including Eckardt 25-gauge “twin light” chandelier illumination system, which provides homogenous lighting and fewer shadows than with single fibers [7], 25-gauge Tornambe Torpedo (Insight instruments, Stuart, FL), BrightStar (DORC, Zuidland, the Netherlands), Photon Light Source (Synergetics Inc., St Charles, MO) which uses a brighter xenon light source, or the light systems integrated into vitrectomy machines such as Constellation (Alcon, Fort Worth, Texas, USA), which is the one available in our hospital. A self-retaining 27-gauge chandelier endoilluminator was introduced in 2007 by Oshima [9], and 27-gauge twinlight chandelier illumination system was then introduced by Eckardt [8]. In addition, a 30-gauge dual fiber chandelier (Synergetics Inc.,St. Charles, MO) is available [14].

We observed that the (Baha) technique enabled a safe and effective scleral indentation. However, it was more difficult to perform the indentation in eyes with small palpebral fissures and in the nasal quadrant in eyes with deep sunken globes or high nasal bridges.

The Leyla retractor was previously used in several surgical techniques on other parts of the human body. It enables free movement of the scleral indenter to allow the surgeon to place it easily at the needed position. It can be fixed easily and quickly at the required position using a wing screw. This will allow a gentle, even scleral indentation while the surgeon is given the freedom to use both hands.

In addition, we observed that in the (Baha) technique it was possible to change the position of the indenter easily by unlocking the wing skew and changing the indenter position without removing the Resight objective lens.

We observed that insinuating the scleral indenter in the conjunctival fornix with the concavity of the indenter facing away from the globe, i.e., to use it as a rotator rather than an indenter of the globe provided better exposure of the peripheral retina.

We did not observe any major differences in the safety and efficacy of the indentation done in pseudophakic and phakic eyes using the (Baha) technique.

There are several disadvantages to the current work. The study included a relatively small number of cases. All the surgeries were performed by a single surgeon and in a single center. The technique was evaluated only for a single indication. And it was not evaluated in children.