Sir,

May I thank Banerjee et al1 for their interesting paper pointing out the more thorough examination of fellow eyes allowed under general anaesthetic (GA) in patients who are difficult to examine for various reasons, and that missed retinal pathology is often found compared to a preoperative examination. As they say, symptomatic recent retinal tears are the main indication for prophylaxis and the body of opinion is in favour of treating these. Rarely does a patient have symptomatic pathology in the fellow eye at the time of retinal detachment repair and many would argue about the benefits of treatment of the pathology they found which I presume was asymptomatic. The argument for GA in treatment of retinal detachment must be balanced against the significant advantages of local anaesthetic (LA) over general, especially in the elderly male patients prone to urinary retention following the latter. As in all clinical decisions, a balance has to be struck between the advantages and disadvantages of one means of treatment against another. I would suggest in many PVD detachments easily treated under LA the advantages of local over general anaesthetic outweigh that of finding pathology for which prophylaxis is of no proven benefit.

Also, it would be of interest to know how many of the operated detachments in the study were detachments without PVD, that is, due to round holes or dialysis, where GA would be the norm, and where this applies to fellow eye missed pathology.