Indian Journal of Ophthalmology

LETTERS TO THE EDITOR
Year
: 2018  |  Volume : 66  |  Issue : 6  |  Page : 884-

Response to comment on: Limitied Anterior Vitrectomy in Phacomorphic glaucoma


Ritika Sachdev, Avnindra Gupta, Ritesh Narula, Rashmi Deshmukh 
 Centre for Sight, New Delhi, India

Correspondence Address:
Dr. Rashmi Deshmukh
Centre for Sight, B5/24, Safdarjung Enclave, New Delhi - 110 029
India




How to cite this article:
Sachdev R, Gupta A, Narula R, Deshmukh R. Response to comment on: Limitied Anterior Vitrectomy in Phacomorphic glaucoma.Indian J Ophthalmol 2018;66:884-884


How to cite this URL:
Sachdev R, Gupta A, Narula R, Deshmukh R. Response to comment on: Limitied Anterior Vitrectomy in Phacomorphic glaucoma. Indian J Ophthalmol [serial online] 2018 [cited 2020 Jul 6 ];66:884-884
Available from: http://www.ijo.in/text.asp?2018/66/6/884/232843


Full Text



Dear sir,

We would like to thank the authors for the critical appraisal of our article on surgical technique of limited anterior vitrectomy in phacomorphic glaucoma.[1]

As the authors have correctly pointed out that the cannula is not exactly or diametrically opposite to the corneal incision,[2] it should be at least a quadrant away from the site of corneal incision. For example, in a temporal phacoemulsification, the cannula would be placed in the inferior or inferonasal quadrant and not in the inferotemporal quadrant. This is for ease of performing the procedure and to prevent corneal wound gaping while removing the cannula.

It is true that the safest position of placing the cannula is inferotemporal. This is because it allows free movement of eyeball in vitreous surgery. However, in our technique, we do not need to rotate the eyeball, and hence, the cannula can be placed in any of the quadrants. In our series, we did not have any case where placing the cannula in nasal quadrant caused any injury to the lids or inadvertent retinal damage. Many a times, in our retinal surgery, we switch ports for dissection of membranes and perform a temporal vitrectomy, as and when required.

As we have described, vitreous is allowed to egress and is cut using vitrectomy cutter, but the cannula is plugged before starting the phacoemulsification procedure.[2] In fact, it is recommended not to leave the cannula open. Intraoperatively, if and when there is a vitreous upthrust, it can be intermittently reopened to perform vitrectomy and reduce the vitreous pressure.

Egression of vitreous is a passive phenomenon occurring due to the difference between intraocular pressure and atmospheric pressure. Passive egression does not cause any traction on the vitreous base. Routine retinal examination was done for all the patients in our series of 32 patients and we have had no complications so far.

We feel that the procedure described by us is much safer than doing a blind vitrectomy, which can cause hypotony/choroidal detachment or an accidental damage to the posterior capsule. It also increases the risk of retinal complications.[3]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Mehta I, Kalapad SJ, Bhosale T, Ramchandani S. Comment on: Limited vitrectomy in phacomorphic glaucoma. Indian J Ophthalmol 2018;66:883.
2Sachdev R, Gupta A, Narula R, Deshmukh R. Limited vitrectomy in phacomorphic glaucoma. Indian J Ophthalmol 2017;65:1422-4.
3Dada T, Kumar S, Gadia R, Aggarwal A, Gupta V, Sihota R, et al. Sutureless single-port transconjunctival pars plana limited vitrectomy combined with phacoemulsification for management of phacomorphic glaucoma. J Cataract Refract Surg 2007;33:951-4.