Issa et al could progress postoperatively to retinal breaks is important to minimize postoperative retinal detachment. Although this study had the strength of being a single surgeon series, being retrospective the findings could poten- tially be affected by a number of confounders. We examined a number of preoperative factors to ensure the groups were matched, including two measures of vitreoretinal adhesion, known to be the key issue in surgical complexity of PDR cases. The groups were well matched in terms of age and vitreoretinal adhesions. Use of wide angle viewing, and other surgical techniques and equipment other than gauge, were consistent between the two groups. The period when the surgeon was changing from 20 gauge to 23 gauge TSV was specifically avoided to avoid confounding the complexity between the groups. However, it is impossible in a study of this nature to exclude a learning effect by the surgeon completely in terms of reducing retinal break formation. 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