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Outcomes of small-gauge vitreoretinal surgery without scleral-depressed shaving of the vitreous base in the era of wide-angle viewing systems
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  • Published on:
    No vitreous base shaving: one size does not fit all
    • Dhananjay Shukla, Consultant Vitreo-retinal Surgeon Ratan Jyoti Netralaya, Gwalior, INDIA

    Tabandeh and colleagues[1] presented a contrarian viewpoint on the redundancy of scleral-depressed vitreous base shaving: a procedure we have come to take for granted during vitrectomy for retinal detachment (RD). Their excellent outcomes are great news for trainee surgeons, as lens touch is likely during meticulous base dissection in phakic eyes. Sutureless micro-incision vitreous surgery is indeed more secure with residual peripheral vitreous, which plugs the sclerotomy leaks. The authors’ attribution of their high success rate to circumferential laser photocoagulation is validated by a randomized clinical trial.[2] The cases with residual silicone oil (13/89; 15%) should however not be included in the anatomical success; a significant percentage of them re-detach after oil removal.[3]
    The optional use of scleral buckle in this study is confusing. The authors have not specified the choice of buckle (most probably an encircling belt-buckle). Vitreous base-shaving is critical to anatomical success when no encirclage is used.[3] The authors reported no additional benefit from buckling, though it was preferentially performed for complex detachments. We therefore do not have clarity about the one moot issue this study could settle: whether vitrectomy sans base-shaving is good enough for simple RD at least. A recent study suggested that anterior dissection is essential in the presence of posteriorly inserted vitreous base.[4] Did the authors observe this vitreous config...

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    Conflict of Interest:
    None declared.