Response to comment on: Comparison of the clinical outcomes of Eyecryl™ and Tecnis® toric intraocular lenses: A real-world study

Dear Editor,

We thank Sarkar[1] for the interest shown and comments on our article.[2] We agree that a prospective randomized control study might provide more meaningful results, as we had mentioned in the limitations of the study. The present study was a retrospective study to evaluate the postoperative uncorrected distance visual acuity and refractive outcomes of cataract patients with corneal astigmatism following implantation of two common toric intraocular lenses (IOLs) used in our hospital. As the study had a 1-year time-bound retrospective design between January 2020 and January 2021, the sample size was the number of eyes that underwent toric IOL implantation during that time. The sample size was not precalculated as in a prospective study design.

We have also mentioned the inclusion of multiple surgeons as one of the study limitations. Both types of toric IOLs were implanted by a total of six surgeons, and the preoperative axis markings were done by the respective operating surgeon as mentioned in the study “methods”. Also, we stated that the viscoelastic substance was completely removed to avoid further rotation of the IOL, to highlight the importance of viscoelastic removal. We agree with the remarks put forward by Sarkar[1] regarding the toric IOL alignment. The final IOL alignment should be done after removing the viscoelastic and hydrating the wounds. The IOL should be placed about 3°–5° anticlockwise of the final desired IOL position during alignment, as most of the open-loop IOLs can be rotated only clockwise, and a rerotation may be required if the IOL rotates clockwise of the target axis during these maneuvers.[3]

We believe that the early postoperative intraocular pressure spike due to incomplete viscoelastic removal is not related to the type of toric IOL used and hence was not considered as an outcome measure. Postoperatively, the axis of implanted toric IOL was assessed with the fully dilated pupil at the slit lamp, a rotating slit, and a rotational gauge by the same observer. We apologize to the readers for not mentioning the number of observers. In the study limitations, we have already mentioned that the vector analysis of residual astigmatism to evaluate changes in refractive astigmatism was not performed, and the mean deviation of IOL from the target position was not adequately assessed due to a lack of devices such as ray tracing aberrometry in our setting. We appreciate the comments given by Sarkar for our study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.