Sir,

We thank Bataung Mokete and Tom Williamson for their interest in our paper and their comments. Inferior detachment was defined as detachment of the retina below the 3 and 9 O’clock meridian. At least one horseshoe tear was present between the 4 and 8 O’clock meridian in every case.

Our study1 focused on this particular subgroup, as these patients have in our experience, the highest risk of recurrence and failure. We found a 95% primary success rate and in addition, our study was not restricted by the numbers of horseshoe tears present as was the case in the papers to which they refer.2, 3

Round or atrophic holes (included in the report by Martinez-Castillo et al2) can be safely managed without the need for vitrectomy or internal tamponade with a 98% success rate4 so that inclusion of these cases might be expected to result in a more favourable outcome. We did not refer to their smaller study as with only 15 cases, we considered the numbers insufficient for comparison.3

The study by Martinez-Castillo et al2 reports an ‘initial’ success of 90%, after which 10% re-detached. An alternative interpretation of these figures would be an 80% primary success rate, if using the same outcome criteria as our own for comparison of the two studies. This does not therefore support the notion that this group of patients can be managed as effectively and successfully with vitrectomy alone, if primary success is used as the main outcome criterion.

Two of the key findings of our study were the lack of any significant buckle-related problems and that over 50% of fellow eyes exhibited or developed significant pathology. This figure surprised us and perhaps suggests that patients with retinal detachment and inferior horseshoe tears may be at greater risk of bilateral detachment than we had previously recognised.