Comment on: Sandwich technique using a combination of perfluoropropane and silicone oil for inferior retinal detachment.

Sir,

We read with interest the technique described by Singh et al.[1] for the management of inferior retinal breaks in rhegmatogenous retinal detachment. They describe the combined use of perfluoropropane (C3F8) gas and silicone oil to support inferior retinal breaks. We have a few concerns regarding the proposed technique.

First, the role of preexisting proliferative vitreoretinopathy (PVR) changes at the time of presentation has not been considered while describing the indication for using this technique. Inferior retinal detachments with minimal PVR have been shown to settle well with just the use of short-acting gases such as sulfur hexafluoride (SF6).[2] Second, the role of 240 style encircling silicone band has not been mentioned. Retinal detachments with inferior breaks tend to have superior outcomes when supplemented with an encircling silicone explant.[3] Third, with the proposed upright positioning in this technique, the silicone oil ceases to have any role as soon as the gas starts getting absorbed. This can lead to reopening of the inferior break and promotes the formation of PVR. An underfill of silicone oil further leads to complications such as early emulsification (seen in representative case in Fig .2 at 2 months), raised intraocular pressure, and corneal decompensation which adversely affect the visual outcome.[4] Two out of the four cases reported had a decline in visual acuity from the preoperative levels. Last, the follow-up of the cases described is very short to validate the technique. PVR formation has been shown to occur at a median interval of 2 months after surgery.[5] Only one case out of the four has a follow-up longer than 2 months and that case developed re-detachment due to PVR. Given the lack of clinical evidence and the poor functional outcomes, this technique needs a reappraisal before it can be put to a widespread clinical use.

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Conflicts of interest

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