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LETTER TO THE EDITOR
Year : 2015  |  Volume : 63  |  Issue : 1  |  Page : 80-81

Author's response Comments on Repeat gas insufflation for successful closure of idiopathic macular hole following failed primary surgery


Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India

Date of Web Publication16-Feb-2015

Correspondence Address:
Pukhraj Rishi
Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, 18 College Road, Chennai - 600 006, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


PMID: 25834855

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How to cite this article:
Rishi P, Reddy S, Rishi E. Author's response Comments on Repeat gas insufflation for successful closure of idiopathic macular hole following failed primary surgery. Indian J Ophthalmol 2015;63:80-1

How to cite this URL:
Rishi P, Reddy S, Rishi E. Author's response Comments on Repeat gas insufflation for successful closure of idiopathic macular hole following failed primary surgery. Indian J Ophthalmol [serial online] 2015 [cited 2019 Dec 10];63:80-1. Available from: http://www.ijo.in/text.asp?2015/63/1/80/151495

Dear Editor,

We thank the authors for their interest in our article. [1] We welcome their inputs and opinion about "inner retinal dimpling" and "temporal retinal thinning." Their observation about the fundus picture 2 weeks after the repeat procedure not showing "any" gas bubble is pertinent. However, it is noteworthy that residual gas bubble in the superior fundus is not seen in the picture. Their contention on the likelihood of a wound leak causing premature escape of gas and a similar leak during the first surgery causing its failure seems unlikely because we did not encounter any hypotony in the postoperative period on both occasions. Also, the surface tension of the gas bubble may not allow its rapid escape. However, possible causes could include sub-optimal gas fill or its rapid absorption.

We would also like to add that we always prefer to perform a thorough removal of the peripheral vitreous to reduce the risk of vitreous incarceration in the sclerotomy. At conclusion of surgery, we irrigate the sclerotomies to check for possible leakage. If there is any leakage from any of the sclerotomies, we perform a gentle massage of the sclerotomy with a cotton-tipped applicator. If there is still leakage, we do not hesitate placing a single 7.0 Vicryl suture through the sclerotomy to close it. We cannot emphasize enough that suture closure of sclerotomies avoids the risk of postoperative hyptony, choroidal detachment or choroidal hemorrhage.

 
  References Top

1.
Rishi P, Reddy S, Rishi E. Repeat gas insufflation for successful closure of idiopathic macular hole following failed primary surgery. Indian J Ophthalmol 2014;62:363-5.  Back to cited text no. 1
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