|LETTER TO THE EDITOR
|Year : 2014 | Volume
| Issue : 6 | Page : 751
Rahul Bhargava1, Prachi Kumar2, Shiv K Sharma3, Sumat Sharma4, Namrata Mehra1, Anuraag Mishra1
1 Department of Ophthalmology, Santosh Medical College and Hospital, Ghaziabad, India
2 Department of Pathology, Santosh Medical College and Hospital, Ghaziabad, India
3 Department of Ophthalmology, Rotary Eye Hospital, Palampur, Himachal Pradesh, India
4 Department of Radiodiagnosis, Max Group of Hospitals, New Delhi, India
|Date of Web Publication||8-Jul-2014|
Dr. Rahul Bhargava
B2-004, Ananda Apartments, Sector-48, Noida Uttar Pradesh - 201 301
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bhargava R, Kumar P, Sharma SK, Sharma S, Mehra N, Mishra A. Authors' Reply. Indian J Ophthalmol 2014;62:751
We Thank Joshi RS.  The article was converted to brief communication and was constrained due to word limit. 
- I agree that it can be challenging to persuade any patient for an invasive procedure because of potential surgical risks and complications like endophthalmitis. This point has been addressed twice in the article (Discussion). Having said this, there have been numerous reports of endophthalmitis following neodymium-doped: yttrium aluminum garnet (ND:YAG) laser capsulotomy ,
- Recurrence of pearls and need for repeated procedure is a potential disadvantage of the procedure and has been mentioned in the study. We are not convinced that interchange of ACM and aspiration cannula would really minimize the incidence of recurrence of pearls. The cause of recurrence of pearls is not epithelial cells in the subincisional area but regenerative cells (E cells) in the equatorial lens bow.  Currently, it is not possible to totally get rid of these regenerative cells by any aspiration method known. However, we are of the opinion that dialing of IOL in the capsular bag before peeling and aspiration and the hydrodynamic flow of irrigating fluid throughout the procedure loosens and washes out these sequestered lens epithelial cells. This point has been mentioned in the text. Secondly, CKB cannula has great manoeuvrability (>300 degrees) when advanced from 10'o clock position and can easily remove subincisional pearls
- Viscoelastics cannot be used simultaneously with the anterior chamber maintainer
- Change of effective lens position will certainly lead to visual disability but only in cases of toric and multifocal IOL's, and we have not advocated this procedure in such patients
- We agree that some patients were less than 45 years and point is well taken. However, the 20 patients lost in follow up were those who were excluded from the study
- The 186 eyes that had a final BCVA of 20/20 at 3 months do not imply that they were not followed up subsequently. The final vision in these (n = 189) patients did not reduce at last follow-up visit
- Means of groups were compared with t tests. Chi-square tests were used for proportions. Pre- and post-procedural vision was compared with McNemar' tests (Abstract).
| References|| |
Joshi RS. Comments on peeling and aspiration of posterior capsular epithelial pearls. Indian J Ophthalmol 2014;62:750.
Bhargava R, Kumar P, Sharma SK, Sharma S, Mehra N, Mishra A.Peeling and aspiration of elschnig pearls! An effective alternative to Nd:YAG laser capsulotomy. Indian J Ophthalmol 2013;61:518-20.
Mochizuki K, Murase H, Sawada A, Suzuki T. Detection of staphylococcus species by polymerase chain reaction in late-onset endophthalmitis after cataract surgery and posterior capsulotomy. Clin Experiment Ophthalmol 2007;35:873-5.
Chaudhary M, Baisakhiya S, Bhatia MS. A rare complication of Nd: YAG capsulotomy: Propionibacterium acnes endophthalmitis. Nepal J Ophthalmol 2011;3;80-2.
Pandey SK, Apple DJ, Werner L, Maloof AJ, Milverton EJ. Posterior capsule opacification: A review of the aetiopathogenesis, experimental and clinical studies and factors for prevention. Indian J Ophthalmol 2004;52:99-112.