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LETTER TO EDITOR |
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Year : 2007 | Volume
: 55
| Issue : 1 | Page : 78 |
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Long-term anatomical and visual outcome of vitreous surgery for retinal detachment with choroidal coloboma
Arvind Dubey
Akansha Apartment, Lalitpur Colony, Gwalior, MP, India
Correspondence Address: Arvind Dubey Akansha Apartment, Lalitpur Colony, Gwalior, MP India
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/0301-4738.29508
How to cite this article: Dubey A. Long-term anatomical and visual outcome of vitreous surgery for retinal detachment with choroidal coloboma. Indian J Ophthalmol 2007;55:78 |
Dear Editor,
We read with interest the article by Pal et al .[1] and have the following observations to make.
- Authors conclude that pars plana vitrectomy (PPV) with silicon oil tamponade improves long term anatomical and visual outcome. We can understand that PPV with silicon oil results in anatomical reposition of retina in almost 100% of such cases but the procedure has any influence on the visual outcome de novo cannot be said.
- Authors have stated that only eyes with retinal detachment related to coloboma of choroid were analysed but they have included such cases also wherein intraoperative peripheral iatrogenic tears were caused which were treated by buckling, therefore by strict definition their inclusion criteria is not as stated in the text.
- Authors have mentioned use of 'peripheral encircling buckles' for taking care of iatrogenic breaks at one place while at other place they have mentioned placement of encircling band for the same cases. Both these things are different. The expression encircling band means a 360 degree narrow silicon band generally 2.5 mm in width which produces indentation by virtue of shortening of the band. Whereas encircling buckle indicates a buckle broader than encircling band wherein the effect of indentation is obtained by adequately spaced mattress sutures. Generally the iatrogenic breaks created during vitreous base surgery are large or moderately large in size and these tears soon increase in size during intraoperative maneuvering. It is unlikely that such tears can be adequately buckled with encircling band without the risk of fish mouthing. Such tears normally require placing a segmental circumferential buckle 5 mm, 7 mm or even wider in size. If the iatrogenic tear is small enough with silicon oil tamponade no buckling is really necessary.
- Authors state that it is a rare theoretical possibility for a retinal detachment caused by peripheral breaks with the sub retinal fluid extending in to the coloboma. To our observation such an event is not uncommon.
- Authors have further stated that air fluid exchange and internal drainage was performed through a retinal break at the margin of or within the choroidal coloboma and another retinotomy was created if this maneuver did not result in flattening of retina. We cannot identify any reasons for retina not to flatten with air fluid exchange through an existing break, but to flatten with the same procedure through another retinal break which is created. Authors have also not mentioned the site of drainage retinotomy in any of their cases.
- Authors have mentioned recurrence of retinal detachment in 11.9% of silicon oil filled eyes. They have stated that in four cases it was because of proliferative vitreo retinopathy changes and in one case it was due to a new break outside the coloboma. No description has been given to the site, size and type of retinal break and also no justification has been offered to call it a new break, it could well be an iatrogenic break ignored at the time of first surgery. As the break has been described to be outside the area of coloboma it is most likely to be located in the superior half of retina, it is unlikely that in a silicon oil filled eye such a break will result in recurrent retinal detachment.
- Authors have stated that 'complete vitrectomy' with silicon oil tamponade is an effective method for treating retinal detachment with choroidal coloboma while they have said lens was removed only in 30 eyes. It is not possible to do a complete vitrectomy in phakic state in colobomatous eyes as such and also because of small size of eyes and normal antero posterior diameter of crystalline lens.
References | | |
1. | Pal N, Azad RV, Sharma YR. Long term anatomical and visual outcome of vitreous surgery for retinal detachment with choroidal coloboma. Indian J Ophthalmol 2006;54:85-8. |
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