Indian Journal of Ophthalmology

LETTER TO THE EDITOR
Year
: 2021  |  Volume : 69  |  Issue : 1  |  Page : 191-

Response to comments on: Management of fovea-involving dry macular fold complicating retinal detachment surgery: Does delay intervention influence outcome?


Naresh Babu1, Jayant Kumar2, Piyush Kohli1, Pushpanjali Ramteke1,  
1 Department of Vitreo.Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
2 Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India

Correspondence Address:
Dr. Jayant Kumar
Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu
India




How to cite this article:
Babu N, Kumar J, Kohli P, Ramteke P. Response to comments on: Management of fovea-involving dry macular fold complicating retinal detachment surgery: Does delay intervention influence outcome?.Indian J Ophthalmol 2021;69:191-191


How to cite this URL:
Babu N, Kumar J, Kohli P, Ramteke P. Response to comments on: Management of fovea-involving dry macular fold complicating retinal detachment surgery: Does delay intervention influence outcome?. Indian J Ophthalmol [serial online] 2021 [cited 2021 Mar 3 ];69:191-191
Available from: https://www.ijo.in/text.asp?2021/69/1/191/303305


Full Text



The Editor,

We thank the authors for their interest in our article.[1] We also sincerely appreciate the modifications suggested by them.[2] The authors suggest performing internal limiting membrane (ILM) peeling before injecting subretinal balanced salt saline (BSS) to increase the retinal compliance as well as the probability of retinal fold opening. However, performing such a maneuver may not be always possible, especially in the case of folds with complex configurations like the roll-cake fold described by Mori et al.[3] In such complex cases, ILM peeling over the area of the macular fold can be performed only after releasing the fold.

Further, the authors recommend against performing a retinotomy to remove the subretinal BSS. They propose that this will avoid the need for using a long-term tamponade and hence another surgery to remove it; while the BSS is expected to get absorbed in 3–4 days. However, we should not forget that incomplete subretinal fluid (SRF) drainage is itself one of the risk factors for postoperative macular fold formation. Hence, effort should be made to remove the residual SRF completely. We believe that it is safer to perform a posterior retinotomy and completely remove the subretinal BSS than leaving it behind and risking yet another macular fold.[4],[5] However, this may come at the cost of injecting a long-term postoperative tamponade and hence another surgery to remove it.

The authors also advise avoiding using perfluorocarbon liquid (PFCL) and massaging the retina with diamond-dusted membrane scraper (DDMS) in the retinal fold for a shorter duration. We agree that these maneuvers may be unnecessary. However, if the macular fold does not unfold, such maneuvers may become necessary. We agree that the surgeons need to exercise caution while massaging retina with DDMS to avoid iatrogenic injury. Silicon tip cannula is another instrument that can be used to massage the retina.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Babu N, Kumar J, Kohli P, Ramteke P. Management of fovea-involving dry macular fold complicating retinal detachment surgery: Does delayed intervention influence outcome? Indian J Ophthalmol 2020;68:1197-9.
2Singh SR, Dogra M. Comments on: Management of fovea-involving dry macular fold complicating retinal detachment surgery: Does delayed intervention influence outcome? Indian J Ophthalmol 2021;69:190-1.
3Mori R, Nakashizuka H, Machida Y, Shimada H, Yuzawa M. Postoperative roll cake-like macular fold after retinal detachment surgery. Int Ophthalmol 2018;38:767-70.
4Isaico R, Malvitte L, Bron AM, Creuzot-Garcher C. Macular folds after retinal detachment surgery: The possible impact of outpatient surgery. Graefes Arch Clin Exp Ophthalmol 2013;251:383-4.
5Gupta RR, Iaboni DSM, Seamone ME, Sarraf D. Inner, outer, and full-thickness retinal folds after rhegmatogenous retinal detachment repair: A review. Surv Ophthalmol 2019;64:135-61.