Reply

We thank Drs. Kumawat and Chawla1 for their interest and insightful comments on our study titled “Comparative analysis of retinal reattachment surgery with or without internal limiting membrane peeling to prevent postoperative macular pucker.”2 First, the authors mention in their introducing comments that many other factors are responsible for epiretinal membrane (ERM) formation including duration of retinal detachment, proliferative vitreoretinopathy (PVR), number of retinal breaks, size of retinal breaks, and postoperative anti-inflammatory treatment, etc. We entirely agree with the authors and have hence performed a regression analysis to see the confounding influence of factors (with sufficient numbers in our data set) such as PVR and presence of giant retinal tears on ERM formation in our series. Yet, the authors have commented that these issues have not been addressed. In our opinion, ERM is an extension of the PVR process, and irrespective of the underlying cause, advance PVR grade C2 or more has risk of developing ERM, also internal limiting membrane (ILM) peeling can be extremely challenging in a detached retina with extensive PVR, so we have excluded them from our study. Reliability of preoperative optical coherence tomography for macular thickness and morphology in RD depends on configuration of detached retina, PVR changes, and media opacities. Considering these facts, it was not possible to evaluate preoperative optical coherence tomography findings in all the cases. In our study, we have defined the presence of ERM on optical coherence tomography even if it did not affect visual acuity and may not have been obvious on slit-lamp biomicroscopy. Functional outcome in terms of visually significant ERM during the follow-up (visual acuity less than 0.5 log MAR) developed in four of seven eyes in ILM peeling group and 18 of 25 eyes of non–ILM-peeling group. In our article, we have already enumerated various complications and retinal structural changes after ILM peeling. It is clearly mentioned that we do not report any such complications in our study. Finally, the authors conclude by saying that larger prospective randomized controlled trials studying morphological and functional changes may be needed before we practice ILM peeling in all retinal detachment surgeries which echoes the concluding remarks of our original publication verbatim