Dear Editor,We read with interest the article by Horozuglu et al.1 We make
the following observations.The authors state that ′duration of macular detachment′ was
recorded. It is possible to elicit the duration only by history-
taking, as the subjective method is likely to be inaccurate.
The authors have not mentioned the details of this finding
in the article. If the duration of macular detachment was
recorded, a correlation with the location of break, and post-
operative visual gain should have been expressed.The authors state that after pars plana vitrectomy (PPV), per
fluorocarbon liquid (PFCL) was injected and immediately
PFCL-air exchange was done, and endolaser was applied
under air. This means that retina could flatten under air only.
Why was then PFCL injected initially? Fluid-air exchange
with endo drainage would have been enough. Use of PFCL
was superfluous and if this was done, endolaser could have
been applied under PFCL as it gives better visualization
than air, closer approximation of neurosensory retina and
retina pigment epithelium, making it possible to use low
laser power.Authors have mentioned the number of retinal breaks, and
the size of retinal detachment in Table 1 of their article, but
not the location. Only gas tamponade has been used and
inferior breaks are not likely to close with gas tamponade and
posture alone. Were all the breaks superior in location?The authors mention the use of sodium hyaluronate 1%
to fill up anterior chamber to prevent passage of air in
anterior chamber. Air can come to anterior chamber only
if posterior capsule has a break and in such a situation,
viscoelastic also cannot prevent it. Viscoelastic is injected
in anterior chamber and will lie on the surface of IOL
and the surrounding intact posterior capsule. Opening in
posterior capsule is generally under IOL and will not be
blocked by viscoelastic. Air enters the eye under pressure
and will always move up, while viscoelastic will settle
down with gravity. It is difficult to accept that viscoelastic
will prevent the entry of air in anterior chamber, except
when there is tight fill of viscoelastic in anterior chamber
creating high positive pressure to keep the air pushed back.
This will mean injection of a large amount of viscoelastic
in anterior chamber. The authors have not mentioned the
amount injected by them. The authors state that a prone
posture was maintained for five days. This as such will
keep the gas/air back, leaving viscoelastic in the anterior
chamber; this appears unnecessary and can give rise to
complications.The authors state ′increased patient comfort ′is an
advantage of this procedure, while they mention to keep
prone posture for five days. In case of superior breaks and
PPV with sutures, prone posture is not needed; rather an
erect or a chin-down posture is needed, and there is no
risk of gas leak as the sclerotomies are closed. Have they
maintained a prone posture to prevent leakage of gas as
the sclerotomies were not sutured? It is contrary to their
claim of patient comfort or they have done so to take care
of inferior breaks? In that case, they have not given any
details of location of breaks, which to our mind is the most
important information about a case of retinal detachment?
In any case, inferior breaks will require a buckle.