Vitrectomy and gas for inferior break retinal detachments: are the results comparable to vitrectomy, gas, and scleral buckle? | British Journal of Ophthalmology

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Vitrectomy and gas for inferior break retinal detachments: are the results comparable to vitrectomy, gas, and scleral buckle?

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Authors' reply to Madhusudhana
Louise Wickham
Published on: 22 March 2016
Vitrectomy with and without scleral buckle for inferior retinal detachment
Dennis S.C. Lam
Published on: 22 March 2016
Possible error in Venn Diagram
Krishnappa C Madhusudhana
Published on: 22 March 2016

Published on: 22 March 2016
Authors' reply to Madhusudhana
- Louise Wickham
- Other Contributors:
  M Connor and G W Aylward
Dear Editor
We thank Dr Madhusudhana for drawing our attention to an error in our recent publication.[1] The correct Venn diagram showing the distribution of retinal breaks in detached retina is available here as a PDF (printer friendly file). Correct Venn Diagram
Reference
1. L Wickham, M Connor, and G W Aylward Vitr...
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Dear Editor
We thank Dr Madhusudhana for drawing our attention to an error in our recent publication.[1] The correct Venn diagram showing the distribution of retinal breaks in detached retina is available here as a PDF (printer friendly file). Correct Venn Diagram
Reference
1. L Wickham, M Connor, and G W Aylward Vitrectomy and gas for inferior break retinal detachments: are the results comparable to vitrectomy, gas, and scleral buckle? Br J Ophthalmol 2004; 88: 1376-1379.
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Conflict of Interest:
None declared.
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Published on: 22 March 2016
Vitrectomy with and without scleral buckle for inferior retinal detachment
- Dennis S.C. Lam, Professor and Doctor
- Other Contributors:
  Yolanda Y.Y. Kwong, C.W. Tsang, Wico W. Lai, and Dennis S.C. Lam
Dear Editor
In the article presented by Wickham and associates,[1] the authors compared vitrectomy and gas for treating inferior break retinal detachments with vitrectomy, gas and scleral buckle. The study showed no significant difference in the final outcome between the two groups. While vitrectomy and gas for inferior break retinal detachments appears promising, there are several issues that we would like to ra...
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Dear Editor
In the article presented by Wickham and associates,[1] the authors compared vitrectomy and gas for treating inferior break retinal detachments with vitrectomy, gas and scleral buckle. The study showed no significant difference in the final outcome between the two groups. While vitrectomy and gas for inferior break retinal detachments appears promising, there are several issues that we would like to raise.
First, the surgery was performed by either a registrar, fellow or consultant. These surgeons may have varying degrees of experience and the inconsistency may affect the rate of successful surgical outcome. Second, additional tears were treated with cryotherapy or laser. As shown by Bonnet M et al,[2] the post-operative proliferative vitreoretinopathy (PVR) rate could be as high as 25.8% in patients treated with cryotherapy as compared to 2.2% in the laser group. It is unclear what the relative distribution of patients who underwent cryotherapy in the two groups was and this may have been a confounding factor in the study. Third, patients underwent an air/gas exchange with either SF6 or C3F8. As C3F8 had a much longer duration of tamponade than SF6, the use of one agent over another may have lead to a difference in the success rate.
The study excluded patients with PVR grade C. However, for those with grade A or B, a scleral buckle was planned before the operation. This could lead to a selection bias where potentially more difficult cases were scheduled into the scleral buckle group. This may be a contributing factor for a higher rate of post-operative PVR (20%) and epiretinal membrane formation in this group, compared to a rate of 5-10% reported previously.[3 -4] The underlying vitreo-retinal pathology rather than the placement of the scleral buckle may have been a major reason behind the high PVR rate noted in this group.
The authors stated that the main reasons for performing vitrectomy and gas without scleral buckle was to avoid the possible complications of scleral buckle, namely, longer operating time,[5] exposure, refractive change, diplopia and anterior segment ischaemia.[6-10] Perhaps, in the interest of readers, the authors can provide us with the information if any of these complications developed during the study.
The high rate of final reattachment reported in the study is encouraging. We believe that vitrectomy and gas alone is an effective method to treat selected cases of retinal detachments with inferior retinal breaks. A controlled, randomized, prospective study, comparing the outcome in properly matched groups and with meticulous attention to surgical methods [11] will help address some of the above issues and help elucidate further if the procedure without the use of scleral buckle will benefit patients with inferior break retinal detachment.
We would like to commend the authors for conducting this very nice study on an important topic that may provide a better alternative treatment. We wish that the issues that we raise will help broaden the discussion on the topic.
Yolanda Y.Y. Kwong, MRCS C.W. Tsang, MRCS Wico W. Lai, MD, FACS Dennis S.C. Lam, FRCS, FRCOphth Hong Kong, People¡¦s Republic of China
The Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive licence (or non exclusive for government employees) on a worldwide basis to the BMJ Publishing Group Ltd and its licensees, to permit this article (if accepted) to be published in BJO and any other BMJPG products and to exploit all subsidiary rights, as set out in our licence (http://bjo.bmjjournals.com/misc/ifora/licenceform.shtml)
References
(1) Wickham L, Connor M, Aylward GW. Vitrectomy and gas for inferior break retinal detachments: are the results comparable to vitrectomy, gas, and scleral buckle? Br J Ophthalmol 2004;88:1376-1379.
(2) Bonnet M, Guenoun S. Surgical risk factors for severe postoperative proliferative vitreoretinopathy in retinal detachment with grade B PVR. Graefes Arch Clin Exp Ophthalmol 1995;233(12):789-91
(3) Charteris DG, Sethi CS, Lewis GP, Fisher SK. Proliferative vitreoretinopathy ¡V developments in adjunctive treatment and retinal pathology. Eye 2002;16:369-374.
(4) The Retina Society Terminology Committee. The classification of retinal detachment with proliferative vitreoretinopathy. Ophthalmol 1983;90:121-125.
(5) Hakin KN, Lavin MJ, Leaver PK. Primary vitrectomy for rhegmatogenous retinal detachment. Graefes Arch Clin Exp Ophthalmol 1993;231:344-6.
(6) Findall RJ, Norton EW, Curtin, et al. Reduction of extrusion and infection following episcleral silicone implants and cryopexy in retinal detachment surgery. Am J Ophthalmol 1971;71:835-7.
(7) Hayashi H, Hayashi K, Nakao F, et al. Corneal shape changes after scleral buckling surgery. Ophthalmology 1997;104:831-7.
(8) Domniz Y, Cahana M, Avni I. Corneal surface changes after pars plana vitrectomy and scleral buckling surgery. J Cataract Refract Surg 2001;27:868-72.
(8) Fison PN, Chignell AH. Diplopia after retinal detachment surgery. Br J Ophthalmol 1987;71:521-5.
(10) Kwartz J, Charles S, Mc Cormack P, et al. Anterior segment ischaemia following segmental scleral buckling. Br J Ophthalmol 1994;78:409-10.
(11) P Leaver. Expanding the role of vitrectomy in retinal reattachment surgery. Br J Ophthalmol 1993;77:197.
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Conflict of Interest:
None declared.
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Published on: 22 March 2016
Possible error in Venn Diagram
- Krishnappa C Madhusudhana, Senior House Officer
- Other Contributors:
  Thomas S
Dear Editor
We read the interesting article by L Wickham and associates, “Vitrectomy and gas for inferior break retinal detachments: are the results comparable to vitrectomy, gas and scleral buckle?” [1]. They have compared the results of vitrectomy and gas without scleral buckle (Group A) with, vitrectomy and gas with scleral buckle (Group B) for inferior break retinal detachments. We would like to point out to a...
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Dear Editor
We read the interesting article by L Wickham and associates, “Vitrectomy and gas for inferior break retinal detachments: are the results comparable to vitrectomy, gas and scleral buckle?” [1]. They have compared the results of vitrectomy and gas without scleral buckle (Group A) with, vitrectomy and gas with scleral buckle (Group B) for inferior break retinal detachments. We would like to point out to a possible error in the results section.
The authors have shown the distribution of retinal breaks using Venn diagrams. Figure 1 shows that 16 patients in Group A had breaks confined to 4-8 o’clock, 12 patients had breaks in 4-8 o’clock and 12-4 o’clock, 1 had breaks in 4-8 o’clock and 8-12 o’clock and breaks were scattered all around in 1 patient. This comes to a total of 30 patients as against 41 patients included in Group A. This possible error in the diagram gives a false impression that, Group B patients had retinal breaks that were more widely distributed and also probably had more number of retinal breaks in total. We are curious to know about this.
References
(1) L Wickham, M Connor, GW Aylward. Vitrectomy and gas for inferior break retinal detachments: are the results comparable to vitrectomy, gas and scleral buckle? Br J Ophthalmol 2004; 88: 1376-9.
Show Less

Conflict of Interest:
None declared.
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