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We appreciate the comments and suggestions of Avins et al with regard to avoiding retinal fold formation. Their recommendations regarding complete transvitreal drainage of SRF rather than transscleral drainage and the benefit of early prone positioning echo the sentiments discussed in our report. With the recognition of the benefits of posterior retinotomy and "complete" drainage, we have, for all intents and purposes, abandoned the transscleral drainage approach. We have never attempted the technique Avins et al describe of scleral depression to drive fluid into the vitreous after partial fluid gas exchange in eyes drained internally. The use of a posterior retinotomy makes these types of complicated maneuvers unnecessary.We believe the benefit of early prone positioning comes from the fact that the border of previously detached/attached retina is not below (dependent) the bubble meniscus. As discussed in our report, we believe it is the dependent movement of residual
Larrison WI, Frederick AR, Topping TM, Peterson T. Posterior Retinal Folds Following Vitreoretinal Surgery-Reply. Arch Ophthalmol. 1994;112(4):448. doi:10.1001/archopht.1994.01090160021006