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Instruments for ab externo scleral-fixated intraocular lens
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LETTERS
patient came for secondary IOL implantation. Since globe-rupture repair was done, the contact biometry procedure was possible. The IOLMaster was used as needed. Keratometry was performed using a handheld keratometer. Axial length measurement was done by A/B Sonomed. Keratometry and A-scan biometry were performed for both eyes at our center. The IOL power calculation was done using the SRK/II formula and Dahan’s criteria were used while considering IOLs in our pediatric patients and with the aim of attaining emmetropia or to match the refractive error in the fellow eye.1 In response to the point raised, the second surgery was done 6 weeks after the primary repair of the cornea and corneoscleral wound repair, as mentioned in the article. In all of our cases, secondary IOL implantation was performed after the said period. We apologize for the unintended typing mistake about the 219/290 cases. We agree with Drs. Shukhija and Ram’s statement about lensectomy and vitrectomy not being a preferred method, but in the literature variable views exist about the preferred method of traumatic pediatric cataract surgery in children younger than 2 years. When this study was done in 2002 and 2003, lensectory was still a widely popular method. As mentioned, we do not use it routinely but lensectomy is the preferred method in cases of soft and fluffy or other cataract in which vitreous was confirmed or suspected to have prolapsed into the lens. Lensectomy is very safe and can be combined with IOL implantation on retained anterior capsule.2,3 As mentioned in the article, the mean follow-up was up to a year but the range was variable and up to 10 years. We found sulcus-fixated PMMA IOLs are well tolerated.4–10 We regret not mentioning in detail that our aim was to validate the predictive value of the OTS in children with traumatic cataract. Our other publications covering the mentioned query have been submitted for publication.dMehul Shah, MD, Shreya Shah, MD, Pramod Upadhyay, MD
REFERENCES 1. Shah M, Shah S, Shah S, Prasad V, Parikh A. Visual recovery and predictors of visual prognosis after managing traumatic cataracts in 555 patients. Indian J Ophthalmol 2011; 59:217– 222. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC3120243/?reportZprintable. Accessed September 20, 2012 2. Thouvenin D. Prise en charge des cataractes de l’enfant: techniques chirurgicales et choix de l’implant [Management of infantile cataracts: surgical technics and choices in lens implantation]. J Fr Ophtalmol 2011; 34:198–202. 3. Taylor D. Choice of surgical technique in the management of congenital cataract. Trans Ophthalmol Soc UK 1981; 101:114–117 4. Kamlesh Dadeya S. Management of paediatric traumatic cataract by epilenticular intraocular lens implantation: long-term
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visual results and postoperative complications. Eye 2004; 18:126–130. Available at: http://www.nature.com/eye/journal/ v18/n2/pdf/6700605a.pdf. Accessed September 20, 2012 Ahmadieh H, Javadi MA, Ahmady M, Karimian F, Einollahi B, Zare M, Dehghan MH, Mashyekhi A, Valaei N, Soheilian M, Sajjadi H. Primary capsulectomy, anterior vitrectomy, lensectomy, and posterior chamber lens implantation in children: limbal versus pars plana. J Cataract Refract Surg 1999; 25:768–775 Basti S, Ravishankar U, Gupta S. Results of a prospective evaluation of three methods of management of pediatric cataracts. Ophthalmology 1996; 103:713–720 Gupta AK, Grover AK, Gurha N. Traumatic cataract surgery with intraocular lens implantation in children. J Pediatr Ophthalmol Strabismus 1992; 29:73–78 Bustos FR, Zepeda LC, Cota O. Intraocular lens implantation in children with traumatic cataract. Ann Ophthalmol 1996; 28:153–157 Eckstein M, Vijayalakshmi P, Killedar M, Gilbert C, Foster A. Aetiology of childhood cataract in south India. Br J Ophthalmol 1996; 80:628–632. Available at: http://www.ncbi.nlm.nih. gov/pmc/articles/PMC505557/pdf/brjopthal00007-0048.pdf. Accessed September 20, 2012 Pandey SK, Ram J, Werner L, Brar GS, Jain AK, Gupta A, Apple DJ. Visual results and postoperative complications of capsular bag and ciliary sulcus fixation of posterior chamber intraocular lenses in children with traumatic cataracts. J Cataract Refract Surg 1999; 25:1576–1584
Instruments for ab externo scleral-fixated intraocular lens Slade et al.1 recently published an excellent description of their technique for ab externo scleral fixation of an intraocular lens. I use a very similar technique and have 2 suggestions that may help anterior segment surgeons who operate at facilities that do not have retinal instruments (microvitreoretinal blade and 25-gauge disposable internal limiting membrane [ILM] forceps) readily available. First, a 22- or 23gauge needle is an inexpensive substitute for making the sclerotomy incisions. Second, instead of the ILM forceps, a Kuglen hook can be passed through the sclerotomy to easily retrieve the suture loops. Although the Kuglen hook is not malleable like the ILM forceps, I find it to be very effective and it is virtually always available. Seth W. Meskin, MD Milford, Connecticut, USA REFERENCE 1. Slade DS, Hater MA, Cionni RJ, Crandall AS. Ab externo scleral fixation of intraocular lens. J Cataract Refract Surg 2012; 38:1316–1321
Glistenings and retinal straylight In the editorial about microvacuoles in hydrophobic acrylic intraocular lenses (IOLs), 1 Dr. Mamalis
J CATARACT REFRACT SURG - VOL 38, DECEMBER 2012
LETTERS
patient came for secondary IOL implantation. Since globe-rupture repair was done, the contact biometry procedure was possible. The IOLMaster was used as needed. Keratometry was performed using a handheld keratometer. Axial length measurement was done by A/B Sonomed. Keratometry and A-scan biometry were performed for both eyes at our center. The IOL power calculation was done using the SRK/II formula and Dahan’s criteria were used while considering IOLs in our pediatric patients and with the aim of attaining emmetropia or to match the refractive error in the fellow eye.1 In response to the point raised, the second surgery was done 6 weeks after the primary repair of the cornea and corneoscleral wound repair, as mentioned in the article. In all of our cases, secondary IOL implantation was performed after the said period. We apologize for the unintended typing mistake about the 219/290 cases. We agree with Drs. Shukhija and Ram’s statement about lensectomy and vitrectomy not being a preferred method, but in the literature variable views exist about the preferred method of traumatic pediatric cataract surgery in children younger than 2 years. When this study was done in 2002 and 2003, lensectory was still a widely popular method. As mentioned, we do not use it routinely but lensectomy is the preferred method in cases of soft and fluffy or other cataract in which vitreous was confirmed or suspected to have prolapsed into the lens. Lensectomy is very safe and can be combined with IOL implantation on retained anterior capsule.2,3 As mentioned in the article, the mean follow-up was up to a year but the range was variable and up to 10 years. We found sulcus-fixated PMMA IOLs are well tolerated.4–10 We regret not mentioning in detail that our aim was to validate the predictive value of the OTS in children with traumatic cataract. Our other publications covering the mentioned query have been submitted for publication.dMehul Shah, MD, Shreya Shah, MD, Pramod Upadhyay, MD
REFERENCES 1. Shah M, Shah S, Shah S, Prasad V, Parikh A. Visual recovery and predictors of visual prognosis after managing traumatic cataracts in 555 patients. Indian J Ophthalmol 2011; 59:217– 222. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC3120243/?reportZprintable. Accessed September 20, 2012 2. Thouvenin D. Prise en charge des cataractes de l’enfant: techniques chirurgicales et choix de l’implant [Management of infantile cataracts: surgical technics and choices in lens implantation]. J Fr Ophtalmol 2011; 34:198–202. 3. Taylor D. Choice of surgical technique in the management of congenital cataract. Trans Ophthalmol Soc UK 1981; 101:114–117 4. Kamlesh Dadeya S. Management of paediatric traumatic cataract by epilenticular intraocular lens implantation: long-term
5.
6.
7.
8.
9.
10.
visual results and postoperative complications. Eye 2004; 18:126–130. Available at: http://www.nature.com/eye/journal/ v18/n2/pdf/6700605a.pdf. Accessed September 20, 2012 Ahmadieh H, Javadi MA, Ahmady M, Karimian F, Einollahi B, Zare M, Dehghan MH, Mashyekhi A, Valaei N, Soheilian M, Sajjadi H. Primary capsulectomy, anterior vitrectomy, lensectomy, and posterior chamber lens implantation in children: limbal versus pars plana. J Cataract Refract Surg 1999; 25:768–775 Basti S, Ravishankar U, Gupta S. Results of a prospective evaluation of three methods of management of pediatric cataracts. Ophthalmology 1996; 103:713–720 Gupta AK, Grover AK, Gurha N. Traumatic cataract surgery with intraocular lens implantation in children. J Pediatr Ophthalmol Strabismus 1992; 29:73–78 Bustos FR, Zepeda LC, Cota O. Intraocular lens implantation in children with traumatic cataract. Ann Ophthalmol 1996; 28:153–157 Eckstein M, Vijayalakshmi P, Killedar M, Gilbert C, Foster A. Aetiology of childhood cataract in south India. Br J Ophthalmol 1996; 80:628–632. Available at: http://www.ncbi.nlm.nih. gov/pmc/articles/PMC505557/pdf/brjopthal00007-0048.pdf. Accessed September 20, 2012 Pandey SK, Ram J, Werner L, Brar GS, Jain AK, Gupta A, Apple DJ. Visual results and postoperative complications of capsular bag and ciliary sulcus fixation of posterior chamber intraocular lenses in children with traumatic cataracts. J Cataract Refract Surg 1999; 25:1576–1584
Instruments for ab externo scleral-fixated intraocular lens Slade et al.1 recently published an excellent description of their technique for ab externo scleral fixation of an intraocular lens. I use a very similar technique and have 2 suggestions that may help anterior segment surgeons who operate at facilities that do not have retinal instruments (microvitreoretinal blade and 25-gauge disposable internal limiting membrane [ILM] forceps) readily available. First, a 22- or 23gauge needle is an inexpensive substitute for making the sclerotomy incisions. Second, instead of the ILM forceps, a Kuglen hook can be passed through the sclerotomy to easily retrieve the suture loops. Although the Kuglen hook is not malleable like the ILM forceps, I find it to be very effective and it is virtually always available. Seth W. Meskin, MD Milford, Connecticut, USA REFERENCE 1. Slade DS, Hater MA, Cionni RJ, Crandall AS. Ab externo scleral fixation of intraocular lens. J Cataract Refract Surg 2012; 38:1316–1321
Glistenings and retinal straylight In the editorial about microvacuoles in hydrophobic acrylic intraocular lenses (IOLs), 1 Dr. Mamalis
J CATARACT REFRACT SURG - VOL 38, DECEMBER 2012