|LETTER TO EDITOR
|Year : 2007 | Volume
| Issue : 6 | Page : 487
Vandana Jain1, Dharmesh Kar2, S Natarajan2, Debraj Shome3, Hitendra Mehta2, Hijab Mehta1, Chaitra Jayadev2, Nishikant Borse2
1 Department of Cornea and External Diseases, Aditya Jyot Eye Hospital Pvt. Ltd., Wadala, Mumbai - 400 031, India
2 Department of Retina, Aditya Jyot Eye Hospital Pvt. Ltd., Wadala, Mumbai - 400 031, India
3 Department of Ophthalmic and Facial Plastic Surgery Orbital Diseases and Ocular Oncology, Aditya Jyot Eye Hospital Pvt. Ltd., Wadala, Mumbai - 400 031, India
Department of Cornea and External Diseases, Aditya Jyot Eye Hospital Pvt. Ltd., Wadala, Mumbai - 400 031
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jain V, Kar D, Natarajan S, Shome D, Mehta H, Mehta H, Jayadev C, Borse N. Authors' reply. Indian J Ophthalmol 2007;55:487
|How to cite this URL:|
Jain V, Kar D, Natarajan S, Shome D, Mehta H, Mehta H, Jayadev C, Borse N. Authors' reply. Indian J Ophthalmol [serial online] 2007 [cited 2020 Feb 25];55:487. Available from: http://www.ijo.in/text.asp?2007/55/6/487/36499
We thank the writer for the interest in our article  and the interesting points that have been raised.
- Our protocol for eyes with combined retinal detachment and cataract was: the other eye was used for intraocular lens (IOL) power calculation, after ensuring that there was no history of anisometropia. The IOL power chosen was adjusted for buckle-induced 2 D of myopic shift (which we have noticed at our center, unpublished data). We have not analyzed the refractive status of all patients as a part of this study, for us to conclusively answer that. However, we rarely see refractive surprises.
- We used IOL master for most of our calculations unless the density of cataract precluded such an investigation. In such situations, we used applanation-based A-Scan biometry. At the time of secondary IOL implantation and silicon oil removal, biometry was performed in silicon oil mode, with reduced velocity, if the A-scan was used. The axial length can be measured reliably with both the A-scan and the IOL master (in silicon oil mode). However, the biometry was not performed in the supine condition to take care of the retro silicon oil space. 
- Primary posterior capsulotomy was not done as a protocol at our institute. We are unaware of any peer-reviewed literature providing evidence that performing primary capsulotomy in these patients provides superior visual rehabilitation. We perform the capsulotomy at the time of silicon oil removal in the event of significant posterior capsular opacification. In fact, we believe that performing capsulotomy at the time of primary surgery may increase the chances of having future complications of oil migration through the capsulotomy opening, subsequent to oil emulsification (which can happen any time). This may be especially true for eyes that are undergoing repeat retinal detachment surgery and thereby having more postoperative inflammation. Thus, we do not see any extra advantage of performing the primary capsulotomy and instead envisage possible deleterious effects of the same. Also, we have noticed (unpublished data), that in some of these cases where the eyes are left aphakic, the posterior and the anterior capsule not only adhere to each other but also stick to the posterior iris surface and may even occlude the inferior peripheral iridectomy (due to the bulge from the silicon oil in the vitreous cavity and postoperative inflammation), thereby causing pupillary block glaucoma. Hence, we do not prefer to leave the patient aphakic until and unless there is a history of anisometropia and the other eye cannot be used for the IOL power calculation. Secondary IOL implantation is an exception rather than the rule.
| References|| |
Jain V, Kar D, Natarajan S, Shome D, Mehta H, Mehta H, et al
. Phacoemulsification and pars plana vitrectomy: A combined procedure. Indian J Ophthalmol
Ghoraba HH, El-Dorghamy AA, Atia AF, Ismail Yassin Ael-A. The problems of biometry in combined silicone oil removal and cataract extraction: A clinical trial. Retina 2002;22:589-96.