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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:
    Authors Response to Dr. Dhananjay Shukla's Correspondence
    • Homayoun Tabandeh, Retina Specialist Retina-Vitreous Associates Medical Group, Los Angeles, California, USA
    • Other Contributors:
      • Nikolas J. S. London, Retina Physician
      • David S. Boyer, Retina Physician
      • Harry W. Flynn Jr., Professor of Ophthalmology

    We thank Dr. Shukla for his interest in our article and his comments 1, 2.
    In our study all consecutive cases of rhegmatogenous retinal detachment (RD) that underwent pars plana vitrectomy (PPV) were included in the study regardless of complexity, type of tear, lens or refractive status, or use of supplemental buckle in order to reduce selection bias and to allow study of various subgroups of patients. For the same reason the 13 cases with silicone oil present at the time of last follow-up were not excluded. The paper referenced by Dr. Shukla reports a retinal re-detachment rate of 13.2% after removal of silicone oil (ROSO), with many of the cases performed prior to the era of small gauge vitrectomy and wide-angle viewing systems (WAVS) 3. Encircling endolaser photocoagulation further reduces the re-detachment rate to 8.6% 4. More recent surgical techniques are likely associated with a lower retinal re-detachment rate. Nevertheless, a presumed retinal re-detachment of 13.2% following ROSO corresponds to an estimated 1.7 eyes with recurrent RD out of the 13 eyes with residual silicone oil in our series 3. This in turn corresponds to a 0.5% difference in the overall single surgery success rate (SSSR) in 312 eyes. It could therefore be safely assumed that inclusion of the small group with silicone oil at the last follow-up visit did not affect the overall success rate significantly, but reduced chances of introducing a selection bias.

    In our series a supplemental...

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    Conflict of Interest:
    None declared.
  • 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.