Sir,
We commend Alexander et al1 on their interesting paper and excellent results. However, information vital to the interpretation of the paper has been left out. This includes their definition of inferior retinal breaks, generally considered to be detachment from the 4 to 8 o'clock position. Variation in this definition would have a bearing on outcomes and our ability to compare with other series. Data in the paper on the number and distribution of retinal breaks are omitted. Comment would have been useful on lens status and visual acuity as well as information on proportions and decision algorithm used for buckling with a silicone sponge or encircling with a 240 band.
A paper from our institution in 20012 stimulated interest in the management of inferior detachment by PPV alone, and since then, several papers have reported on this topic.3 Techniques and results have advanced since and there are two papers by Martinez-Castillo et al4, 5 we feel should have been considered in the discussion. In pseudophakic rhegmatogenous detachment, they demonstrated, with pars plana vitrectomy, laser retinopexy, air, and no posture, 90% primary success.4 In another pseudophakic series, they achieved 93.3% primary success5 and they have more recently confirmed good results with their technique. Both rates are comparable to the figure reported in this paper, and as they were achieved without buckling, it raises the question of its influence (with attendant risks) on outcomes and take us back to previous findings of no difference between groups managed by either method.3 This is where the missing information would aid analysis.
References
Alexander P, Ang A, Poulson A, Snead MP . Scleral buckling combined with vitrectomy for the management of rhegmatogenous retinal detachment associated with inferior retinal breaks. Eye 2008; 22: 200–203.
Tanner V, Minihan M, Williamson TH . Management of inferior retinal breaks during pars plana vitrectomy for retinal detachment. Br J Ophthalmol 2001; 85: 480–482.
Wickham L, Connor M, Aylward GW . Vitrectomy and gas for inferior break retinal detachments: are the results comparable to vitrectomy, gas, and scleral buckle? Br J Ophthalmol 2004; 88: 1376–1379.
Martinez-Castillo V, Boixadera A, Verdugo A, Garcia-Arumi J . Pars plana vitrectomy alone for the management of inferior breaks in pseudophakic retinal detachment without facedown position. Ophthalmology 2005; 112: 1222–1226.
Martinez-Castillo V, Verdugo A, Boixadera A, Garcia-Arumi J, Corcostegui B . Management of inferior breaks in pseudophakic rhegmatogenous retinal detachment with pars plana vitrectomy and air. Arch Ophthalmol 2005; 123: 1078–1081.
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Mokete, B., Williamson, T. Scleral buckling combined with vitrectomy for the management of rhegmatogenous retinal detachment associated with inferior retinal breaks. Eye 23, 1233 (2009). https://doi.org/10.1038/eye.2008.171
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DOI: https://doi.org/10.1038/eye.2008.171