Author Affiliations: Department of Ophthalmology, New York Eye and Ear Infirmary, New York, and New York Medical College, Valhalla (Dr Gentile); and Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston (Dr Eliott).
We thank Barak and colleagues for their comments and agree that it is important that all of the silicone oil retention sutures be oriented in the same plane. Even though our original recommendation of positioning the sutures 1 mm from the limbus to simulate an iris diaphragm does place the sutures in the same plane,1 their modification helps ensure their alignment. Silicone oil retention sutures can be placed in different patterns depending on the exact pathology without sacrificing their ability to prevent silicone oil endothelial touch. The techniques used will depend on both the clinical scenario and the surgeon's ingenuity. As we have gained more experience in performing silicone oil retention sutures, we have found other helpful techniques that incorporate interweaving of the silicone oil retention sutures. In one such case with superior scleral thinning after open globe repair, we had success with a triangular pattern of suture placement (Figure). Compared with our original technique that required four 10-0 Prolene sutures with 8 passes across the anterior chamber, the triangular pattern uses only 2 sutures with 5 passes. As Barak and colleagues have recommended, we have been interweaving the sutures except when corneal opacity prevents adequate intraoperative visualization. We have also found these sutures helpful after removal of the silicone oil in aiding in the implantation of an artificial iris intraocular lens (Ophtec USA Inc). We expect additional modifications and uses for silicone oil retention sutures in the future.
Gentile RC, Eliott D. Modification of Silicone Oil Retention Sutures in Aphakic Eyes With Iris Loss—Reply;. Arch Ophthalmol. 2012;130(9):1231-1232. doi:10.1001/archophthalmol.2012.1616