The study by Cheng and associates one short-term external buckling with pneumatic retinopexy treating retinal detachment with inferior retinal breaks gives us new insight. Rhegmatogenous retinal detachment (RRD) with inferior breaks usually is a contraindication for pneumatic retinopexy. Although the authors challenged this restricted area and obtained good results (the rate of successful retinal reattachment within 6 months was 87.9%), as some other vitreoretinal specialists did, the vitreous traction may persist after the removal of the external buckle and gas being absorbed. Does this mean vitreous traction is not an important issue for retinal reattachment, and intraoperative transconjunctival cryopexy and supplementary laser photocoagulation applied around the retinal breaks combined with chorioretinal adhesive force are enough for long-term effects in most cases of primary RRD? As a result, further observation could be added to verify the hypothesis. Vitreous traction could be observed by some means such as optical coherence tomography through the entire follow-up period. Does vitreous traction persist, or is it released because of vitreous liquefaction, after cryopexy and laser photocoagulation?
In addition, is pneumatic retinopexy really needed? Pneumatic retinopexy often has been used for primary RRD surgery with superior breaks (a break located between the 8-o’clock and 4-o’clock positions), but seldom has been recommended for those with inferior breaks because the surface tension of gas is weakened for closing the inferior retinal breaks as a result of the position in the eyeball. Moreover, it could cause some complications such as large intraocular pressure rise, cataract, new retinal breaks, and so forth. If short-term external buckling is enough for retinal reattachment, an invasive procedure could be avoided.
We hope the authors offer more convincing evidence in the future. If vitreous traction is not important and pneumatic retinopexy is not needed, RRD surgery would be simplified, which would be a real innovation for RRD surgery. A conjunctival incision no longer would be needed and the primary RRD surgery would become a minimally invasive external eye surgery. It would be enjoyed not only by surgeons, but also by patients.