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LETTER TO EDITOR
Year : 1999  |  Volume : 47  |  Issue : 3  |  Page : 205

Author's reply


Correspondence Address:
S P Deshpande


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Source of Support: None, Conflict of Interest: None


PMID: 10858782

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How to cite this article:
Deshpande S P. Author's reply. Indian J Ophthalmol 1999;47:205

How to cite this URL:
Deshpande S P. Author's reply. Indian J Ophthalmol [serial online] 1999 [cited 2019 Sep 16];47:205. Available from: http://www.ijo.in/text.asp?1999/47/3/205/14911


  Dear Editor: Top


I have noted Dr. S.P. Deshpande's comments and would like to clarify the points she has made.

I agree that retrospectively it is obvious that the vitreous must have been disturbed for an IOL to dislocate into the vitreous. However our comments about there being no evidence of vitreous loss were based on the impression that we had preoperatively, hence we did not even feel the need to perform an anterior vitrectomy at the time.

I could not agree more with your statement that an IOL in the vitreous is a time bomb. I would like to draw your attention to the discussion of our report where we have categorically stated that "the ultimate prophylaxis of all problems arising from lens dislocation is its removal or repositioning". I agree that the gold standard for these patients is a vitrectomy with removal of the IOL. In infrequent instances where patients decline a pars plana vitrectomy after being counselled, the option to put an AC IOL without removing the dislocated IOL is real, provided the risks are clearly explained to and understood by the patient. In this particular case we did have access to a vitreoretinal surgeon, but the patient declined to go ahead with this procedure, despite being counselled about the risks of retinal detachment. As quoted in this article there are several case reports of patients being managed in a similar way. Furthermore, this lady had the IOL nearly 6 years ago in 1993 and so far has stood the test of time.

To conclude, we agree that a pars plana vitrectomy with the removal of the IOL is the procedure of choice provided the risks, though small, but significant, are explained to the patient.




 

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