We would like to thank Awasthi et al. [1] for their interest in our paper and their insightful comments.
Phacoemulsification with three-piece intraocular lens (IOL) implantation was done in all phakic patients as we believe that removing the lens gives access to the ora and far retinal periphery and allows dealing with the anterior proliferative vitreoretinopathy (PVR). The axial length was measured using optical biometry (IOL Master; Carl Zeiss, Oberkochen, Germany). If the axial length measured by optical biometry was shorter than that of the other eye, the axial length measurement was verified with A-scan ultrasonography [2]. SRK/T formula with the manufacturer’s recommended A-constant was used to calculate IOL power. The axial length adjustment with Wang–Koch modification was applied. The refractive value in the other eye determined the refractive aim in the operated eye.
In the Buckle group, 360 degrees encircling silicone band was inserted through four scleral tunnels at the beginning of surgery before phacoemulsification or inserting any trocars. The surgeries were done by two groups of surgeons according to their surgical preference, the first group adopted vitrectomy combined with scleral buckle and the second group adopted vitrectomy with retinectomy. Baseline characteristics of both groups were not statistically different which indicate that both groups were similar without any bias towards any of the two groups.
Heavy Silicon Oil Study which compares heavy and standard silicone oil (SO) in patients with inferior PVR failed to demonstrate superiority of a heavy tamponade [3]. Moreover, several complications have been associated with heavy SO surgery, such as prolonged intraocular inflammation and intraocular pressure increase, probably due to the early emulsification of heavy SO [4]. That is why we preferred to use SO (5000 cs) as a tamponading agent which has the least rate of emulsification [5].
The mean postoperative IOP was significantly higher in the Buckle group throughout the whole follow-up period. This may be due to impaired venous drainage from the vortex veins, leading to congestion of the ciliary body. The edematous ciliary body is displaced anteriorly, shifting the lens-iris diaphragm forward and resulting in narrowing of the angle [6]. Visual acuity was better at first month in the Buckle group, but this difference disappeared throughout the remaining follow-up period, achieving the same functional outcome.
The number of patients prevented subgroup analysis for the grades of PVR. Performing a prospective larger study for better statistical analysis will be a great idea. Once again, we would like to thank Awasthi et al. for sharing their comments.
References
Awasthi U, Grover R, Videkar C, Varshney A. Comment on “Vitrectomy with scleral buckling versus with inferior retinectomy in treating primary rhegmatogenous retinal detachment with PVR and inferior breaks”. Eye. 2018; epub ahead of print 18 December 2018.
Rahman R, Bong CX, Stephenson J. Accuracy of intraocular lens power estimation in eyes having phacovitrectomy for rhegmatogenous retinal detachment. Retina. 2014;34:1415–20.
Joussen AM, Rizzo S, Kirchhof B, Schrage N, Li X, Lente C, et al. Heavy silicone oil versus standard silicone oil in as vitreous tamponade in inferior PVR (HSO Study): interim analysis. Acta Ophthalmol. 2011;89:e483–9.
Theelen T, Tilanus MAD, Klevering BJ. Intraocular inflammation following endotamponade with high-density silicone oil. Graefes Arch Clin Exp Ophthalmol. 2004;242:617–20.
Zafar S, Shakir M, Mahmood SA, Amin S, Iqbal Z. Comparison of 1000-Centistoke versus 5000-Centistoke Silicone Oil in complex retinal detachment surgery. J Coll Physicians Surg Pak. 2016;26:36–40.
Gedde SJ. Management of glaucoma after retinal detachment surgery. Curr Opin Ophthalmol. 2002;13:103–9.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Eleinen, K.G.A., Mohalhal, A.A., Ghalwash, D.A. et al. Vitrectomy with scleral buckling versus with inferior retinectomy in treating primary rhegmatogenous retinal detachment with PVR and inferior breaks. Eye 33, 853–854 (2019). https://doi.org/10.1038/s41433-018-0312-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41433-018-0312-z