Sir,

Recently, we presented a relatively new technique of zonulo-hyaloido-vitrectomy for the treatment of malignant glaucoma.1 It was clearly stressed in the manuscript that it is not entirely new and several modifications of the technique have been described before. Authors of preceding papers were cited except for Lois et al2 because of journal space constraints. In our opinion, our technique described in details should be used as the procedure of choice in similar cases and could be easily performed by anterior segment surgeons. Complete TPPV is not only unnecessary but also sometimes ineffective, and the occurrence of severe complications is more likely. Our case series of 10 eyes with 12-month follow-up had 100% success with no complications. Until now our group has enlarged to 18 eyes with extended follow-up and the results are the same. If performed promptly after the occurrence of symptoms, filtering blebs could be salvaged. I am curious that a procedure described some time ago has not been fully investigated and has not become more widespread. Therefore, we aimed to remind the scientific community of that procedure.

We are familiar with the review paper of Ng and Morgan3 that is concentrated on the mechanisms of primary angle closure in general, including malignant glaucoma. It shows very didactically the theoretical concept of aqueous misdirection and the possible way of treatment. We found the idea of the resistance of aqueous flow depicted in the electrical circuit analogue diagram especially suggestive. Their review cites the paper of Lois et al presenting a similar technique successful in a case series of five eyes with 5-month follow-up. That modification of the technique is performed by vitreoretinal surgeon and the cutter is introduced through cornea, 1–2 clock hours away from the iridectomy site, probably in order not to engage the bleb. However, this makes the tip of the vitrector almost invisible through the pupil that might be dangerous, and it compromises the extent of core vitrectomy behind the posterior capsule. In our opinion, our efficacious modification of the technique is very simple and safe and is dedicated to be performed routinely by the cataract/glaucoma surgeon.