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LETTER TO THE EDITOR
Year : 2019  |  Volume : 67  |  Issue : 1  |  Page : 185-186

Response to comment on: Sandwich technique using a combination of perfluoropropane and silicone oil for inferior retinal detachment


Academy for Eye Care Education, LV Prasad Eye Institute; Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India

Date of Web Publication21-Dec-2018

Correspondence Address:
Dr. Jay Chhablani
Smt. Kanuri Santhamma Centre for Vitreo.Retinal Diseases, LV Prasad Eye Institute, Banjara Hills, Hyderabad - 500 034, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1290_18

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How to cite this article:
Singh SR, Dhurandhar D, Chhablani J. Response to comment on: Sandwich technique using a combination of perfluoropropane and silicone oil for inferior retinal detachment. Indian J Ophthalmol 2019;67:185-6

How to cite this URL:
Singh SR, Dhurandhar D, Chhablani J. Response to comment on: Sandwich technique using a combination of perfluoropropane and silicone oil for inferior retinal detachment. Indian J Ophthalmol [serial online] 2019 [cited 2019 Mar 20];67:185-6. Available from: http://www.ijo.in/text.asp?2019/67/1/185/248117



Sir,

We would like to thank Singh et al. for their interest and valuable comments related to our study.[1],[2] Among the four patients, none of the patients had fixed retinal folds i.e., proliferative vitreoretinopathy (PVR) grade C while two patients had presence of PVR grade B. The study by Tan et al. which has been quoted by Singh et al. had excluded the patients with inferior retinal breaks between 4 o'clock to 8 o'clock.[2],[3] So a direct extrapolation of their results to our series may not be accurate. In our series, breaks were located in inferior half of fundus in all the patients with case 3 showing multiple inferior breaks, while case 4 was a recurrent retinal detachment with inferior break. We however, agree that cases with primary rhegmatogenous retinal detachment (RRD) with inferior breaks and up to grade B PVR may have a good anatomical outcome even with gas tamponade.[4] The main advantage with our technique is that postoperative prone positioning may not be required.

We did not use scleral explants in any of the eyes. In our study, we intended to study the effect of pars plana vitrectomy alone without the use of any additional procedure like scleral explants. Also, segmental explants may not be needed in all inferior breaks related RRD. As already discussed in the paper, the chorioretinal adhesions start forming in the early postoperative period with maximum strength at 2 weeks. So, we hypothesize that by the time of significant recession of the gas bubble, adequate chorioretinal adhesion would have formed to maintain the retina in position. The concern regarding early emulsification has already been listed as one of the limitations in our study. In order to have more detailed information about PVR changes postoperatively, we revisited our cases since a significant time had elapsed after the primary surgery. The clinical details of the patient are shown in [Table 1]. Case 4 was a case of recurrent retinal detachment with inferior PVR changes. Post sandwich technique, retina remained attached, however, corneal decompensation ensued. During silicone oil removal, pale disc was noted and thus further surgeries were deferred. The corneal decompensation as seen in case 4 may not be directly related to silicone oil since the patient already had multiple vitreoretinal surgery and was left aphakic. Therefore, silicone oil may not be the sole reason for corneal decompensation in this case. The present report is a “proof of concept” pilot study with small sample size. We wish to plan a randomized study with larger sample size and longer follow up for further validation of this surgical approach.
Table 1: The preoperative and postoperative details of the patients who underwent sandwich technique (14% C3F8) and silicone oil (1000 cs) injection

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Financial support and sponsorship

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Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Singh SR, Dhurandhar D, Chhablani J. Sandwich technique using a combination of perfluoropropane and silicone oil for inferior retinal detachment. Indian J Ophthalmol 2018;66:988-90.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Singh SR, Dogra M, Dogra MR. Comment on: Sandwich technique using a combination of perfluoropropane and silicone oil for inferior retinal detachment. Indian J Ophthalmol 2019;67:185.  Back to cited text no. 2
  [Full text]  
3.
Tan HS, Oberstein SY, Mura M, Bijl HM. Air versus gas tamponade in retinal detachment surgery. Br J Ophthalmol 2013;97:80-2.  Back to cited text no. 3
    
4.
Tanner V, Minihan M, Williamson TH. Management of inferior retinal breaks during pars plana vitrectomy for retinal detachment. Br J Ophthalmol 2001;85:480-2.  Back to cited text no. 4
    



 
 
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