Indian Journal of Ophthalmology

LETTER TO EDITOR
Year
: 2001  |  Volume : 49  |  Issue : 3  |  Page : 203-

A letter


Santhan KS Gopal 
 Kamala Nethralaya, No. 81, First Floor, 4th Block, Opposite BDA Complex, Koramangala, Bangalore - 560 034, India

Correspondence Address:
Santhan KS Gopal
Kamala Nethralaya, No. 81, First Floor, 4th Block, Opposite BDA Complex, Koramangala, Bangalore - 560 034, India




How to cite this article:
Gopal SK. A letter.Indian J Ophthalmol 2001;49:203-203


How to cite this URL:
Gopal SK. A letter. Indian J Ophthalmol [serial online] 2001 [cited 2022 Jan 28 ];49:203-203
Available from: https://www.ijo.in/text.asp?2001/49/3/203/22641


Full Text

Dear Editor,

With respect to the article "Postoperative Astigmatism after Intracapsular Surgery" by Dipak Nag et al, Indian J Ophthalmol (2001;49:31-35). I would like to mention the following points.

The main conclusion of the authors is that there is a high risk of large astigmatism in eyes with AC IOL following intracapsular cataract extraction (ICCE).

Do the authors suggest that ICCE, AC IOL should not be encouraged even in an eye camp?

Postoperative astigmatism following cataract surgery is dependent on a number of factors including preoperative astigmatism, type and length of incision, sutures type and material, timing of suture removal, wound leakage, and the degree of suture tightening. To blame the presence of AC IOL solely on high astigmatism in these cases is not entirely fair. What also needs to be looked into is the quality of unaided vision in these patients with AC IOL and high astigmatism as compared to the quality of unaided vision with no IOL.

I am certain that the quality of vision with AC IOL even with high astigmatism is far superior to that of unaided aphakic vision, even if the astigmatism is nil! I would have been more interested to compare the unaided vision of the 69 patients with acceptable astigmatism in the aphakic spectacle group with that of 289 AC IOL patients with high astigmatism.

I feel in selected situations and settings there is still a place for ICCE and AC IOL, despite the risk of astigmatism.

 In reply



The authors thank the writers of both letters for their valuable comments. We would like to respond to some of the issues raised by Dr. Santhan Gopal.

In spite of the higher risk of astigmatism after ICCE and AC IOL implantation, the authors feel that the modern type of flexible AC IOL is a safe lens, which can be implanted after ICCE. We refer to the published results of visual acuity with and without an AC IOL.[1,2] However, we would like to stress that AC IOLs should be implanted only by experienced ICCE eye surgeons who have consistently good results. If complications occur during surgery, such as vitreous in AC or wound leakage, then implantation of an AC IOL increases the risk of postoperative complications.

Surgical eye camps vary greatly in their quality. In principle we believe that base hospital surgery is preferable. The implantation of AC IOLs in eye camp situations is a sensitive issue. Good results have been demonstrated by Kapoor[3] with ECCE/PC IOL in Ludhiana surgical camps.

Albretch Hennig, MD

Correspondence to Dr. A. Hennig, C/o UMN, P.O. Box 126, Kathmandu, Nepal.

E-mail: <[email protected]>

References

1Hennig A, Evans JR, Pradhan D, Johnson GJ, Pokhrel RP, Gregson RM, et al. Randomised controlled trial of anterior-chamber intraocular lenses. Lancet 1997;349:1129-33.
2Evans JR, Hennig A, Pradhan D, Johnson GJ, Pokhrel RP, Gregson RM, et al. Randomised controlled trial of anterior-chamber intraocular lenses in Nepal: Long term follow-up. Bull World Health Organ 2000;78:372-78.
3Kapoor H, Chatterjee A, Daniel R, Foster A. Evaluation of visual outcome of cataract surgery in an Indian Eye Camp. Br J Ophthalmol 1999;83:3.