To the Editor

We read the article by Eleinen and Mohalhal [1] with great interest. We applaud them to do head on comparison of scleral bucklng (SB) and retinectomy (RR) as a primary approach in patients with rhegmatogenous retinal detachment (RRD) with proliferative vitreoretinopathy (PVR) with inferior breaks. However, we would like to comment upon few points.

In phakic patients, cataract surgery was done in the same sitting prior to RD surgery. Authors should have mentioned the method of IOL power calculation. In our experience it is better to pass the buckle before phacoemulsification and intraocular lens (IOL) implantation as maneuvering during buckling may cause anterior chamber instability and IOL decentration. Surgeries were done by multiple surgeons. Different surgeons have different approach for a case so it would have affected the decision for preferring one surgical technique over the other. Also, it would have been more informative if the criteria for preferring surgical technique would have been mentioned.

Authors have preferred 5000cS silicon oil in all cases with oil removal at 3 months. High viscosity silicon oils are preferred in cases where long term or permanent tamponade is required [2]. Moreover, 5000cS oil is lighter than water, thus inflammatory cytokines get settled in inferior unsupported space leading to inferior PVR changes [3]. So, if inferior tamponade was the purpose of preferring 5000cS, then heavy oils would have been better choice [4].

Authors have done regression analysis for finding correlation of seven factors with recurrence of RD. In multivariate regression, testing too many variables for the small sample size will overestimate associations.

Causes of higher IOP and better visual acuity in buckle group should have been discussed. Subgroup analysis for the grades of PVR would have been more informative regarding dealing with severe PVR. We appreciate authors for their choice of doing photocoagulation of bare choroid in cases of RR. Once again we applaud authors for sharing their experience.