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LETTER TO EDITOR
Year : 2016  |  Volume : 4  |  Issue : 2  |  Page : 104-105

Letter to the editor in response to the article "Surgical technique to avoid deroofing in advanced vitreomacular traction"


1 Private Practice at Shivam Eye Foundation, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India
2 Department of Ophthalmology, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India

Date of Web Publication9-Jun-2016

Correspondence Address:
Neha Dhiware
15, Narmada, Plot 24A, Sector 14, Vashi, Navi Mumbai - 400 703, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2320-3897.183725

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How to cite this article:
Ramchandani S, Dhiware N, Patkar P, Paritekar P. Letter to the editor in response to the article "Surgical technique to avoid deroofing in advanced vitreomacular traction". J Clin Ophthalmol Res 2016;4:104-5

How to cite this URL:
Ramchandani S, Dhiware N, Patkar P, Paritekar P. Letter to the editor in response to the article "Surgical technique to avoid deroofing in advanced vitreomacular traction". J Clin Ophthalmol Res [serial online] 2016 [cited 2020 Sep 20];4:104-5. Available from: http://www.jcor.in/text.asp?2016/4/2/104/183725

Sir,

We read with great interest the article by Prabhushanker Mahalingam, Kumar Sambhav, and Geetha Ganesan, on "Surgical technique to avoid deroofing in advanced vitreomacular traction" in your journal. [1] We would like to congratulate the authors for an excellent surgical technique described by them, but we would like a few clarifications.

The preoperative optical coherence tomography (OCT) image shows anteroposterior traction with a macular hole and a thin foveal roof. Besides, there is also an epiretinal membrane (ERM) causing tangential traction. Hence, it is possible that the macular hole is because of both these pathologies, with the anteroposterior traction being more dominant than the tangential traction. In our opinion, our surgical planning would have involved relief of both the tangential and the anteroposterior traction. We agree with the authors' concern that looking at the preoperative OCT; an intraoperative macular hole formation is a real possibility if we do an ERM stripping as well as an internal limiting membrane (ILM) peeling.

Although a full thickness macular hole has not occurred after the surgery, as is evident from the postoperative OCT images, the tangential traction in the form of an ERM is still persisting. This has prevented the inner layers of the retina from coming together. The serial OCT images, in fact, show that, although the subretinal fluid has got absorbed, there is atrophy of the outer plexiform and inner nuclear layers, together with the vitreous tag, resulting in a wider partial thickness hole. The ERM is more prominent in the last OCT.

It would not be surprising that the tangential traction would increase the size of the partial thickness hole and eventually result in a full thickness hole in the near future. [2],[3]

A better result would have probably been achieved if we had to strip the ERM as well as peel the ILM at the time of surgery. This would have relieved the tangential traction effectively, allowing the macular hole (which has formed intraoperatively) to eventually close. [4] After all, we can close a majority of full thickness holes with the modern vitreoretinal surgery; so a hole produced during surgery will not have behaved too differently as far as the rate of closure is concerned. [2] We operated on a similar case with this technique. The preoperative OCT picture of the patient we operated on, showed thin foveal roof with ERM [Figure 1]. The results can be seen in the postoperative OCT images [Figure 2]a and b.
Figure 1: Preoperative optical coherence tomography image

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Figure 2: (a and b) Two weeks postoperative optical coherence tomography showing almost normal foveal contour

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However, we feel that there is scope for using this technique in cases where there is only anteroposterior traction. Hence, a surgical planning based on OCT is very important.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Mahalingam P, Sambhav K, Ganesan G. Surgical technique to avoid deroofing in advanced vitreomacular traction. J Clin Ophthalmol Res 2015;3:153-5.  Back to cited text no. 1
  Medknow Journal  
2.
Saxena S, Holekamp NM, Kumar A. Diagnosis and management of idiopathic macular holes. Indian J Ophthalmol 1998;46:185-93.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Witkin AJ, Ko TH, Fujimoto JG, Schuman JS, Baumal CR, Rogers AH, et al. Redefining lamellar holes and the vitreomacular interface: An ultrahigh-resolution optical coherence tomography study. Ophthalmology 2006;113:388-97.  Back to cited text no. 3
    
4.
Shukla D, Rajendran A, Kim R. Macular hole formation and spontaneous closure after vitrectomy for central retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 2006;244:1350-2.  Back to cited text no. 4
    


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  [Figure 1], [Figure 2]



 

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