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Dear editor  The article entitled “Comparison of the effect of W-shaped and linear skin incisions on scar visibility in bilateral external dacryocystorhinostomy” by Ekinci et al1 was published in Clinical Ophthalmology; I reviewed this paper for another journal (Journal of Ophthalmology) several months ago before it appeared in your journal.  It seems that the authors submitted their rejected paper to your journal, after making some unethical, methodological changes.  The major differences between the two versions of the same manuscript are as follows:  The rejected manuscript states that the study was conducted “between January 2009 and June 2012” (42 months). However, the published manuscript states that the study was conducted “between June 2011 and June 2012” (12 months).  The rejected manuscript states that “The mean follow-up time was 14.1±5.84 (7–25) months for the WS incision group and 29.4±5.08 (24–40) months for the LS incision group”. These periods and follow up times show that the dacryocystorhinostomy (DCR) surgeries with linear shape (LS) incision were performed about 15 months before the DCR surgeries with W-shaped (WS) incisions. These follow up times, however, are removed from the published version of the manuscript.  Another significant issue arises when the scar assessments times are compared in the rejected and published versions. In the rejected version, the scar assessment time was reported as “6 months after the second surgery”, “Scars were scored 6 months after the second surgery […]” (in the Abstract) and “The skin incisions were assessed 6 months after the second procedure by […]” (in the Materials and methods). Taking into account the mean follow-up times reported in the rejected manuscript, the scar assessment must take place about 15 months apart for each group.  However, the published paper reports that the scar assessment took place “6 months after each procedure”. See the Materials and methods section paragraph 1 and 3 stating: “The skin incisions were assessed 6 months after each procedure by […]” and “The surgeries were not simultaneous, so assessment of scar visibility on each side was done at the 6-month postoperative visit to prevent one side being more healed than the other at evaluation.”1  This last sentence is like a response to one of the reviewer’s comments on the rejected manuscript and explains the motivation of the authors for this change in the published version. Given that both the rejected manuscript and the published paper derived results from the same cohort of patients, a serious question arises with regard to the truthfulness of the method and data in the published paper.  Another potential issue involves a schematic drawing of the WS incision included in the rejected version of the manuscript. This drawing shows that the arms of the WS incision are unequal: the two inner arms toward the nasal dorsum are 8 mm in length (two times longer than the outer arms). However, in the methods section of the text (in the both rejected and published versions), the W shape was described as follows: “The W shape was formed by three consecutive equilateral triangles having sides 4 mm in length with two tips and one base that showed the medial canthus”. Another paper written by these authors, which was previously published in the journal Orbit, also included the similar discrepancy between the drawing and text.2 This discrepancy becomes unnoticeable when the authors removed the drawing from the published version.  In addition to these discrepancies, another issue I have with this paper is that the idea of a W-shaped incision is presented as original. This idea appeared first in our department in the form of a specialization thesis, in which equal W-shaped and linear incisions were compared.3 This technique represents a significant advancement in external dacryocystorhinostomy surgery. I have discussed this technique and performed live surgeries at several national meetings in Turkey over the past 8 years. Although Ekinci et al knew about these presentations and the thesis, they presented this method as original research. It is disappointing when fellow academicians adopt such strategies for academic promotion.