Sir,

We thank Mansoor et al1 for their interest in our article ‘Subretinal migration of trypan blue during macular hole and epiretinal membrane peel: an observational case series. Is there a safer method?’2 We acknowledge their alternative technique and agree that because the dye would come out of the side port of the vitrectomy probe it would also reduce the risk of fluid getting under the retina and owing to less instrument exchange there is less chance of iatrogenic retinal tear or introduction of infection.

Regarding their comment about their technique improving the flow of the surgery, we note that the authors contradict their original comment, wherein they mentioned about the dead space that might dilute the dye injection and that the system needs priming to avoid this dead space interfering with the dye injection. This process is a whole extra step and hence does not contribute to the flow of the surgery except for the need for less instrument exchange. Our technique of dye injection from a prefilled backflush flute needle delivers concentrated dye at the point of interest.

Further, the technique by Mansoor et al1 needs the injection to be done by an assistant. Although we acknowledge the help of an assistant in such complex procedures, we are also aware of the fact that some incidents wherein subretinal dye injection had occurred were due to accidental forceful dye injection by the assistant, where the surgeon had no control of the dye flow, as documented by Arevalo and Garcia.3

We agree with the fact that for heavy liquids and triamcinolone the transvitrectomy injection may be a safe method, but in situations where the dye has to be injected in a more controlled manner and where the force of the injection itself may be harmful to the retina, we propose that the backflush technique still holds its merits.