Drs Richoz and Schutz in their letter raise 3 main problems with our article to which I will respond.
Concerns were raised regarding the technique that we evaluated because, in their opinion, it is somewhat outdated. The scleral buckling procedure was the only technique used to treat retinal detachment until the development of pneumatic retinopexy and vitrectomy. In a recent study comparing these procedures, scleral buckle was found to be as safe and effective a technique as vitrectomy and had better anatomic results than pneumatic retinopexy. Therefore, we believe that the scleral buckling procedure is a good technique that should be subject to further investigations with the aim of improving its outcomes.
We used an encircling band because, unlike segmental buckles, the band relieves high vitreoretinal traction (especially among highly myopic eyes) and probably decreases the recurrence rate of retinal detachment by proliferative vitreoretinopathy. Intraoperative ocular hypotonia was prevented in all cases by an automatic air injection at 20 mm Hg.
The pathophysiologic features of choroidal detachment are very complex, especially when it occurs after a scleral buckling procedure, and there is a lack of research in this area. Clinically differentiating between serous, sero-sanguinous, and hemorrhagic choroidal detachment usually is difficult, and we believe that their pathophysiology, in this surgical context, is similar. Thus, it seemed more relevant to include all types of choroidal detachment.
We decided to choose systolic blood pressure as a principal outcome in line with our observations of several cases of choroidal detachment in the context of intraoperative arterial hypertension. This choice and the statistical method used in this study stemmed from these observations. We did not select the principal outcome measure after the analysis of the general data.