Management of Delayed Complications of Hydrogel Scleral Buckles
Round 1
Reviewer 1 Report
The authors Hsin-Yu Yang et. al in the article entitled “Management of Delayed complications of Hydrogel Scleral Buckles” have provided insights on complications associated with the Hydrogel Scleral Buckles. Authors have performed a good work on providing a detailed view of the surgical techniques employed to remove the Hydrogel Scleral buckles. This has been explicitly described not only with a step wise procedure but also, with supporting images.
There are minor queries (as listed below) that may further help improvise the article.
- Line # 94: Table 1 describing the patient characteristics – 63.3% of the cohorts were males, 54.5 % of the patients had glaucoma. Out of curiosity, is the information available on patient’s sex vs glaucoma? If so, could this information be included in this table?
- Line # 96: Table 2 listing the symptoms before and after scleral buckle removal. This a good table to learn about the patient’s conditions before and after surgery. In the same fashion, is data available on IOP levels from n=11 patients before and after surgery?
- Did the patients experience dry-eye conditions who had redness and swelling sensation reported?
Author Response
The authors Hsin-Yu Yang et. al in the article entitled “Management of Delayed complications of Hydrogel Scleral Buckles” have provided insights on complications associated with the Hydrogel Scleral Buckles. Authors have performed a good work on providing a detailed view of the surgical techniques employed to remove the Hydrogel Scleral buckles. This has been explicitly described not only with a step wise procedure but also, with supporting images.
There are minor queries (as listed below) that may further help improvise the article.
- Line # 94: Table 1 describing the patient characteristics – 63.3% of the cohorts were males, 54.5 % of the patients had glaucoma. Out of curiosity, is the information available on patient’s sex vs glaucoma? If so, could this information be included in this table?
REPLY: Thank you for the valuable suggestion. The information of patients’ sex v.s. glaucoma status was shown as below.
|
Case number |
Gender (M:male, F:female) |
Glaucoma status (Y: yes, N:no) |
|
1 |
F |
N |
|
2 |
F |
Y |
|
3 |
M |
Y |
|
4 |
M |
Y |
|
5 |
F |
Y |
|
6 |
M |
N |
|
7 |
M |
Y |
|
8 |
M |
N |
|
9 |
M |
N |
|
10 |
F |
N |
|
11 |
M |
Y |
In six patients with glaucoma, four patients (66.7%) were male. However, there is no significance of sex and glaucoma correlation according to Chi-Square analysis (p=0.652). Due to space limitation of table 1, we would like to provide the information only in response letter. We have added the description into the manuscript at line 80-82.
“Among them, four patients (66.7%) were male but there was no significance of sex and glaucoma correlation according to Chi-Square analysis (p=0.652).”
- Line # 96: Table 2 listing the symptoms before and after scleral buckle removal. This a good table to learn about the patient’s conditions before and after surgery. In the same fashion, is data available on IOP levels from n=11 patients before and after surgery?
REPLY: Thank you for pointing out this important issue. We provided the information below.
|
Case number (G medication) |
IOP before surgery (mmHg) |
IOP after surgery (mmHg) |
|
1 |
Not applicable due to bulbar atrophy before surgery |
|
|
2 (G-alphagan, IZBA, carteolol) |
27 |
27 |
|
3 (G-cosopt, xalatan) |
17 |
15 |
|
4 (G-cosopt) |
28 |
21 |
|
5 (G-lumigan, timolol, trusopt) |
35 |
34 |
|
6 (G-duotrav) |
8 |
6 |
|
7 |
15 |
15 |
|
8 |
14 |
15 |
|
9 |
13 |
14 |
|
10 |
12 |
14 |
|
11 (G-alphagan, cosopt, IZBA) |
34 |
19 |
G:glaucoma
As we described at line 119-123. In the six glaucoma patients, four of them showed IOP improvement. However, there was no statistical significance of IOP change before and after HSB removal in the ten cases by Wilcoxon Signed ranks test (p=0.189). We would like to provide the information as table 4. We have modified our manuscript as follows at line 119-125.
“In the six glaucoma patients, four out of them showed IOP improvement. However, there was no statistical significance of IOP change before and after HSB removal in the ten cases by Wilcoxon Signed ranks test (p=0.189, table 4).”
- Did the patients experience dry-eye conditions who had redness and swelling sensation reported?
REPLY: We thank you for the valuable question. According to the medical records of these patients, there was no dry eye-related conditions other than redness and swelling sensation, which is not specific to dry eye disease.
Reviewer 2 Report
The article is interesting even if not particularly original.In the materials and methods it is not explained in which hospital patients underwent surgery for HSB removal. It is not specified whether a silicone encircling band was present overthe hydrogel scleral buckles. More cases are needed to assess the correlation between IOP and the implant
Author Response
The article is interesting even if not particularly original.
In the materials and methods, it is not explained in which hospital patients underwent surgery for HSB removal. It is not specified whether a silicone encircling band was present over the hydrogel scleral buckles. More cases are needed to assess the correlation between IOP and the implant
REPLY: We appreciate your insightful comments. We added them to methods in the manuscript as well as limitations. Please refer to line 53, 113-114, 216-217.
We added the hospital name in the methods at line 53. “We collected all patients with late complications of HSB and underwent surgery for HSB removal in Taipei Veterans General Hospital, a tertiary medical center, from 2004 to 2021.”
We clarified that there were no other implants, including silicone encircling bands present in the study cases at line 113-114. “In the surgical field, there were no implants other than hydrogel scleral buckles found.”
We confessed that more studies need to be performed to confirm the relationship between IOP and the implant at line 216-217. “The relationship between IOP elevation and location of swelling HSB must be proven through further studies.”
Reviewer 3 Report
The topic of the present study is timely and will be of interest to the readers of the journal. Some images and tables were utilized in order to make the content of the text clearer. Until today, due to the short use of HSB, there are no clear guidelines for managing patients with HSB complications. In this context, the authors tried to give some instructions for the management of such patients. The statistical analysis used was appropriate. These are the most important comments.
Author Response
The topic of the present study is timely and will be of interest to the readers of the journal. Some images and tables were utilized in order to make the content of the text clearer. Until today, due to the short use of HSB, there are no clear guidelines for managing patients with HSB complications. In this context, the authors tried to give some instructions for the management of such patients. The statistical analysis used was appropriate. These are the most important comments.
REPLY: We really appreciate your comments. We have been trying our best to demonstrate a proper surgical approach to safely remove this material.
