Comment on - Evaluation of 27-gauge vitrectomy for complex proliferative diabetic retinopathy

To the Editor, We went through the recently published article titled, "Evaluation of twenty-seven-gauge vitrectomy for complex proliferative diabetic retinopathy" by Verma et al.[1] The authors have nicely documented the intraoperative findings. We have a few queries for the authors. The authors have mentioned that the follow-up duration was 3 months and no antivascular endothelial growth factor (VEGF) agents were injected during this period. It will be informative to know if anti-VEGF agents were used before surgery in any of the cases operated and the mean number of days before surgery that they were used. Preoperative use of anti-VEGF agents such as bevacizumab in complex cases of proliferative diabetic retinopathy has been reported to result in reduced operation time, minimized iatrogenic retinal breaks, prevented vitreous hemorrhage, provided better long-term visual outcomes, and reduced the rates of resurgery.[2] More and more surgeons use preoperative anti-VEGF agents in diabetic vitrectomies. Sulfur hexafluoride (SF6) gas is used following diabetic vitrectomies to provide tamponade effect to the iatrogenic retinal breaks. SF6 has also been reported to reduce the chance of early vitreous hemorrhage following diabetic vitrectomies.[3] We usually use a nonexpansile 20% SF6 as the tamponading agent following vitrectomies. It will be good to know the exact concentration of SF6 gas used in the present study. Two different concentrations of the gas have been mentioned in the manuscript. In the surgical procedure section, 16% SF6 and in results, 25% SF6 have been mentioned. It will also be informative for the readers to know the tests for statistical significance used as details of statistical analysis are missing in the manuscript. Lack of a comparative group is an obvious drawback of the present study. The parameters studied should have ideally been compared with 25-G vitrectomy. With further refinements, more and more surgeons will start performing 27-G vitrectomies. As the surgeon's confidence with the instrumentation increases, the indications for performing 27-G vitrectomies are bound to widen. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.