Dear Editor,
Thank you for the interest in our article entitled “Anterior chamber intraocular lens - An effective alternative in traumatic and surgical aphakia in the era of scleral-fixated intraocular lens” published in the Indian Journal of Ophthalmology.[1,2] Here are clarifications to the issues raised by you.
As this was a retrospective study, there was no control group. Furthermore, “ACIOL has a lesser rate of complications such as IOL tilt, vitreous hemorrhage and suture erosion as compared to scleral-fixated IOL” is an analytical statement, not a comparative one. Here we mean to say that the complications of sutured SFIOL, such as IOL tilt, suture erosion, and vitreous hemorrhage, are evidently not possible with ACIOL.[3] Though sutureless SFIOL does not pose these complications, postoperative hypotony, vitreous hemorrhage, and hyphema are known complications of this technique.[4,5,6]
As most of the patients in this retrospective series were operated for ACIOL following cataract surgery complication, preoperative AC depth was not assessed but deep AC with a white-to-white diameter of more than 11 mm was a prerequisite for implantation of ACIOL in all cases in this series to avoid known complications of ACIOL implantation, such as glaucoma, pseudophakic bullous keratopathy, and cystoid macular edema.[7,8,9]
The endothelial cell count preoperatively or postoperatively was not practically possible as most of the patients were operated following complications of free cataract surgery, but all the patients except one in this series maintained a clear cornea for at least 1 year of follow-up giving a clinical indication of good endothelial cell count. This issue is already extensively discussed in the penultimate paragraph of the original article, where it is mentioned that all the patients underwent PPV before ACIOL implantation and the ACIOL was placed upside down to maintain a good AC depth to provide endothelial protection. Moreover, these observations are supported by previous studies which point to surgical trauma generally resulting in endothelial cell count loss rather than specifically implanted ACIOL as the cause of endothelial injury.[8,9] At the same time, this is also mentioned in our article as a limitation of the study suggesting future studies with pre and postoperative endothelial cell count in cases of ACIOL implantation for analyzing its long-term effects.
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Conflicts of interest
There are no conflicts of interest.
References
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