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April 2001

Factors in the Prevention of Wound Dehiscence During Pneumatic Retinopexy

Author Affiliations

Copyright 2001 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2001

Arch Ophthalmol. 2001;119(4):621. doi:

In reply

I would like to thank Dr Tripathi for his comments concerning our case reports. I would certainly agree with the fact that a small, properly constructed wound would have far less risk of dehiscence than would a poorly constructed, larger corneal wound. In fact, one can argue that it is impossible to dehisce a wound that is constructed properly. In reality, however, wounds are not always created precisely and do not necessarily meet the specifications of being watertight under all conditions. In both cases, a small corneal incision was present at the initial visit to the retinal specialist. Also in both cases, the wounds did appear to be sealed, to be small caliber (somewhere between 3 and 4 mm in length), and to be shelved. Despite this fact, they still dehisced during the performance of a pneumatic retinopexy. As we stated in the article, this experience has caused us to rethink placing the gas bubble prior to paracentesis; we now recommend paracentesis first. In my conversations with retinal specialists, I learned that pneumatic retinopexy is routinely performed with the paracentesis following gas injection. There are some advantages to this, the first being that the eye is not soft for the pars plana injection of gas. In addition, this may afford the need for only one paracentesis instead of repeat paracentesis following gas injection. We felt that this article might encourage a rethinking of the paracentesis, particularly in patients who have recently undergone intraocular surgical procedures. We thank Dr Tripathi again for helping to emphasize these conclusions.

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