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| LETTER TO EDITOR |
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| Year : 2003 | Volume
: 51
| Issue : 3 | Page : 283 |
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In reply
Sanjay Kumar Teotia
Correspondence Address:
Sanjay Kumar Teotia
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 14601863 
How to cite this article:
Teotia SK. In reply. Indian J Ophthalmol 2003;51:283 |
We appreciate the interest shown by Dr. Ratnagiri in our article.
Dr. Ratnagiri is correct in raising the point regarding our statement " placement of CTR only after removal of the residual cortex." In a later part of the article we have mentioned that "CTR enhanced safety and efficacy during phacoemulsification and IOL implantation, maintained the circular contour of the capsular bag and avoided collapse of the bag after the lens was removed from the capsule." In our case series CTR placement was done only after thorough cortex removal. However, the above statement should be read as follows: "Gimbel et al, in their review stated that CTR enhanced safety and efficacy during phacoemulsification and IOL implantation, maintained the circular contour of the capsular bag and avoided collapse of the bag after the lens was removed from the capsule." The phrase "Gimbel et al in their review stated that", was inadvertently missed in our manuscript sent to the editor. We thank Dr. Ratnagiri for pointing out this mistake.
The placement of CTR was aborted in two eyes due to anterior capsular tear. Due to the non-availability of Cionni ring during our study period we had no alternative but to offer an explantation of CTR. We have no experience with the alternative technique suggested by Dr. Ratnagiri when Cionni ring is not available.
With the availability of a high viscosity viscoelastic like sodium hyaluronate it was not necessary to initiate the capsulorhexis where the zonules were intact. We initiated capsulorhexis in the conventional manner, making a horizontal knick in the center of the lens with 26-guage bent cystitome and completed the rhexis with a utrata forceps.
With reference to hard cataracts with subluxation, we do not consider it necessary to perform phacoemul-sification in the anterior chamber as it would adversely affect the endothelium. We preferred 'in-the-bag' emulsification by using our techniques of step-by-step chop in situ and lateral separation followed by the step-down technique with controlled fluidics by lowering the infusion bottle, reducing the AFR and appropriate power, thus reducing the stress on the already compromised zonules.
With reference to the technique of hydrodissection mentioned by Dr. Ratnagiri, we understand it makes no difference in performance of phacoemulsification.
Dr. Ratnagiri has suggested that normal manual stripping of the cortex before aspiration would be safer in subluxated cataracts. This point is well taken. It is a useful tip particularly during manual irrigation and aspiration (I/A), and perhaps not necessary in automated I/A.
Finally, we do not regard it necessary to place IOL haptics in the meridian of zonular disinsertion after CTR implantation.
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