Response to query and additional considerations regarding the article “The complication rate following neodymium-doped yttrium aluminum garnet laser posterior capsulotomy for posterior capsular opacification in patients with and without comorbidities”

Dear Editor,

We appreciate the opportunity to respond to the query raised by the esteemed authors regarding our article titled “The complication rate following neodymium-doped yttrium aluminum garnet laser posterior capsulotomy for posterior capsular opacification in patients with and without comorbidities.”[1] We thank them for their kind words and thoughtful consideration.

Regarding the use of preoperative optical coherence tomography (OCT) in all cases, we acknowledge the potential challenges associated with obtaining good-signal OCT images in patients with higher grades of posterior capsular opacity (PCO). We agree that the severity of PCO may affect the quality of OCT images and should be taken into account when interpreting the results. In such cases, it is essential to rely on other clinical assessments and imaging modalities to evaluate the posterior segment. Studies have shown post-neodymium-doped yttrium aluminum garnet (ND:YAG) capsulotomy results in measurable improvement in signal strength.[2,3]

However, certain studies have shown no effect on the signal strength and image quality of scanned images with Spectral domain Optical Coherence tomography (SD-OCT).[4,5] OCT scans yield reliable thickness measurement of the macular before ND:YAG capsulotomy for PCO.[6]

It appears that we inadvertently neglected to specify the particular type of OCT employed in our study. In hindsight, we acknowledge that this information may have been pertinent to our research.

The authors have rightly pointed out the importance of a thorough fundus examination, especially in patients with comorbidities such as nonproliferative diabetic retinopathy (NPDR). We completely agree with their suggestion of performing a comprehensive retinal evaluation, including fundus fluorescein angiography (FFA), to rule out any existing neovascularization before or after the procedure. Neovascularization can pose a risk for complications such as neovascular glaucoma, and appropriate measures, such as pan-retinal photocoagulation, should be considered to prevent potential complications in these cases. We apologize for not emphasizing this important aspect in our original manuscript. It was noted that the patients had preexisting retinal issues, such as age-related macular degeneration, proliferative and nonproliferative diabetic retinopathy, and retinitis pigmentosa, which they were already aware of. ND:YAG was used primarily to clear the visual axis that was obstructed by PCO, which was a necessary step in their treatment and further management of the disease problem.

Furthermore, we appreciate the authors for bringing to our attention a recently reported rare complication of bilateral full-thickness intraocular lens (IOL) defect following ND-YAG laser capsulotomy, as described by Das et al.[7] This case highlights the significance of careful focusing and judicious use of energy during the procedure. We completely agree that ophthalmologists must exercise utmost responsibility when working with ophthalmic lasers to minimize the risk of such complications. We believe that raising awareness about these potential complications will contribute to better patient outcomes.

In conclusion, we would like to express our gratitude to the authors for their valuable insights and suggestions. We will ensure that the points raised in their query and the additional considerations regarding the use of OCT, thorough retinal examination, and responsible laser use are duly addressed and incorporated into future discussions and revisions of our work.

Thank you for giving us the opportunity to provide this clarification and further insights.