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Authors' reply
Submit responseDear Editor
We were pleased to read the letter expressing an interest in our paper. The study was primarily performed to try to question whether and external plombage during surgery by vitrectomy could be avoided. Most surgeons add this step for any patient with rhegmatogenous retinal detachment and any break in the inferior meridien. This was why we chose our data set. Patients with inferior retinal detachments and holes only, which in our experience consist usually of atrophic holes with attached vitreous, were not included because these respond so well to nondrain cryotherapy and explant procedures. Indeed we examined such cases at the time of the data collection and found a 100% success rate without the need for gas or posturing. I do not know the type of patients in the correspondent's study but I look forward to the publication of their paper.
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Inferior retinal detachment or not ?
Submit responseDear Editor, We were highly interested by Sharma et al's paper on inferior-tear retinal detachment (RD) and we would like to make a few remarks. Is there any significant difference between phakic and pseudophakic patients ? When comparing the two techniques, it is worth reminding that vitrectomy will systematically induce cataract within a few years, which will imply secondary surgery. This will considerably increase management costs. We do not fully agree with the definition proposed for this particular RD group. According to Sharma et al, inferior-tear RD is characterised by at least one tear being localised between the 4- and 8-hour meridians. Figure 2 is a good illustration of that, where all three sketches show tears beyond the 3h-9h meridians. It is our view that inferior-tear RD can only be evoked when all tears are between 4 and 8-h meridians. Otherwise, it is not inferior-tear RD but rather superior-tear RD complicated by an inferior tear. Consistently with this definition, inferior-tear RDs appear to induce a high risk of recurrence. Indeed, we found a significantly increased risk of recurrence in such specific RD cases2. We agree with Sharma et al when they underline the importance of postoperative positioning following inferior-tear RD surgery. Several processes have been used. We setup a prospective study in patients operated on for inferior-tear RD by indentation, subretinal fluid drainage and gas injection. We systematically positioned a wire under the right inferior so as to leave the eye under traction for a few days (photos). Bed foot legs were also propped up to give the patient a feet-up posture. Our first results in 10 patients revealed 100% anatomical success with subretinal fluid persistence for 3 months in one patient and we had to reinject gas in another. Management of inferior tear RD is specific and requires more studies like that of Sharma et al, to try and establish a consensus.
References
1. Sharma A, Grigoropoulos V, Wiliamson TH. Management of primary rhegmatogenous retinal detachment with inferior breaks. Br J Ophthalmol 2004;88:1376-1379
2. Quintyn JC, Ponchel C, Fillaux J et al. A. Retinal detachment by inferior tear, bad pronostic ? J Fr Ophtalmol to be published
Competing Interest Statement
No authors have any competing financial interests.
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