Comment on: Anterior chamber intraocular lens - An effective alternative in traumatic and surgical aphakia in the era of scleral-fixated intraocular lens

Dear Editor,

We read the article titled “Anterior chamber intraocular lens - An effective alternative in traumatic and surgical aphakia in the era of scleral-fixated intraocular lens” by Mahapatra SK et al.,[1] published in the Indian Journal of Ophthalmology, with great interest. We want to congratulate the authors for the much-needed and excellent publication, but there are few issues that we would like to raise.

First, there is no control group in the study. The authors have concluded that ACIOL has a lesser rate of complications such as IOL tilt, vitreous hemorrhage, and suture erosion compared to scleral-fixated IOL. However, in the methodology, they did not compare the results of ACIOL with scleral-fixated IOL. We felt that it is not worthy of making such conclusions against an established technique like scleral-fixated IOL without making the comparison.

Second, there has been no mention of the anterior chamber depth in the preoperative workup of these patients. A deep anterior chamber is an essential criterion for ACIOL implantation. ACIOLs in a shallow anterior chamber (<2.8 mm) can lead to complications such as glaucoma, pseudophakic bullous keratopathy, cystoid macula edema, and finally, the need for an IOL explantation.[2]

The authors did not look for endothelial cell counts in their follow-up period. Anterior chamber IOLs are more prone to cause pseudophakic bullous keratopathy or corneal decompensation. They did not mention anything regarding long-term endothelial loss following ACIOL implantation. We understand that as a community eye care center, it is difficult to implant scleral-fixated IOL in every case, but we also think that the conclusion made by the authors is not properly backed by the data or rationale.

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Conflicts of interest

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