Br J Ophthalmol doi:10.1136/bjo.2010.199844
  • PostScript
  • Letter

Endoscope assisted enhanced internal search for iatrogenic retinal breaks in 20-gauge macular surgery

  1. Khalid Al Sabti2
  1. 1Vitreo Retinal Unit, Al Bahar Eye Center, Kuwait
  2. 2Faculty of Medicine, Kuwait University, Kuwait
  1. Correspondence to Dr Seemant Raizada, Al Bahar Eye Center, Ibn Sina Hospital, P.O. Box: 25427, Safat 13115, Kuwait; seemantpolly{at}
  • Accepted 5 December 2010
  • Published Online First 17 January 2011

We read with interest the article by Tan et al.1 We congratulate the authors for emphasising the need for meticulous examination of the peripheral retina to look for retinal breaks after pars plana vitrectomy (PPV). We would like to add some comments to augment this fine study.

  1. We did not completely understand what the authors mean by ‘intensified search strategy’ and ‘enhanced 360° internal search’. Are they proposing any new technique which is different from what is a common practice? It is a common practice to check for peripheral retinal breaks after PPV and we have been doing this in a similar fashion with the help of the Binocular Indirect Ophthalmol Microscope (BIOM) for the last 10 years. This is in fact a routine teaching in all surgical retina fellowship programmes.

  2. The authors reported a very high incidence of retinal breaks. Breaks were seen in 53 eyes (24.3%) out of 218 eyes. Thirty-eight eyes (17.4%) were sclerotomy-related breaks and 21 eyes (9.6%) had breaks elsewhere. We are not questioning the surgical technique, but we feel that there should be some explanation for such a high incidence of retinal breaks. It is possible that some of the retinal breaks were pre-existing breaks without signs of pigmentation, etc. The authors do admit that not all the cases were examined by indirect ophthalmoscope and sclera depression pre-operatively.

  3. In many cases, after PPV it is difficult to examine the retinal periphery with BIOM as recommended by the authors. Peripheral view, at the end of surgery, is difficult in these cases due to cataract, posterior capsular opacification or corneal haze. In these situations, an ocular endoscope is a very valuable instrument. We have been using this endoscope for vitreoretinal surgery and have demonstrated its effectiveness in examining sclerotomy-related complications (eg, vitreous traction, retinal pull, retinal break). An endoscope enables a surgeon to view and simultaneously laser the break.2 One of the authors of the article,1 Dr de Smet, is a well-known proponent of the ocular endoscope.3 We are sure he would also agree that any intensified search strategy or enhanced 360° internal search for peripheral breaks would be augmented by the use of an ophthalmic endoscope.


  • Competing interests None to declare.

  • Provenance and peer review Not commissioned; not externally peer reviewed.


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