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LETTER TO THE EDITOR |
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Year : 2015 | Volume
: 63
| Issue : 1 | Page : 80-81 |
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Author's response Comments on Repeat gas insufflation for successful closure of idiopathic macular hole following failed primary surgery
Pukhraj Rishi, Sumanth Reddy, Ekta Rishi
Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
Date of Web Publication | 16-Feb-2015 |
Correspondence Address: Pukhraj Rishi Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, 18 College Road, Chennai - 600 006, Tamil Nadu India
Source of Support: None, Conflict of Interest: None | Check |
PMID: 25834855
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 |
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 | | |
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. [ PUBMED] |
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