Sir,

We read with great interest the article titled ‘Intrasilicone oil injection of bevacizumab at the end of retinal reattachment surgery for severe proliferative vitreoretinopathy’ by Ghasemi Falavarjani et al.1 We beg to differ on some of the points though.

Proliferative vitreoretinopathy (PVR) is associated with elevated levels of many pro-inflammatory cytokines and growth factors including, vascular endothelial growth factor (VEGF).2 All patients were treated with oral steroids and sub-tenon triamcinolone injections. However, the role of oral steroids in preventing PVR changes in an eye with rhegmatogenous retinal detachment has not been proven conclusively.2 There is no correlation between the levels of inflammatory mediators or growth factors and the severity of PVR and hence an association between them is difficult to prove.2 Improper injections of anti-VEGF agents can worsen tractional retinal detachment in an eye with fibrovascular membranes.3 Similarly, inadequate understanding of the role of VEGF in formation of PVR and thereby the role of anti-VEGF agents in the prevention of PVR can prove detrimental. Bevacizumab injection was given before the closure of inflow sclerotomy in this study. We believe that such a practice might result in the leakage of the injected drug through the open port and hence suggest injecting the drug after closure of all the sclerotomies. The use of encerclage, meticulous dissection of all membranes, adequate vitrectomy, and use of Perfluorocarbon liquids and silicone oil are some of the methods to reduce the chances of retinal redetachment. We appreciate the reporting of the results by the authors though the results were contrary to the hypothesis.