Laser iridoplasty for congenital ectopic pupils

LETTERS

4. Enoch JM, Hope GM. An analysis of retinal receptor orientation. IV. Center of the entrance pupil and the center of convergence of orientation and directional sensitivity. Invest Ophthalmol 1972; 11:1017–1021 5. Yang Y, Thompson K, Burns SA. Pupil location under mesopic, photopic, and pharmacologically dilated conditions. Invest Ophthalmol Vis Sci 2002; 43:2508–2512 6. Schachar RA. Effect of accommodation on the cornea [letter]. J Cataract Refract Surg 2004; 30:531–532 7. Kirkwood BR, Sterne JAC. Essential Medical Statistics, 2nd ed. Malden, MA, Blackwell, 2003; 61–63 8. Indrayan A, Sarmukaddam SB. Medical Biostatistics. New York, NY, Marcel Dekker, 2001; 505–511 9. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1:307–310

Laser iridoplasty for congenital ectopic pupils A recent Consultation Section1 in which a healthy 25-year old man with congenital ectopic pupils and lenses was presented failed to include any responses suggesting laser iridoplasty for the patient’s right eye. In my experience, such a procedure could serve as the sole and definitive management of this eye. Rings of confluent spots can be placed using a green wavelength, thermal laser (such as a solid-state 532 nm or an argon– green laser) and delivered via an Abraham or the center of a 3-mirror lens, with a 0.5 s duration and 500 mm spot size at low enough power to cause stromal contraction without charring the tissue or forming bubbles. This iridoplasty technique will reliably allow the surgeon to enlarge and shape the pupil with a great degree of control. By placing these spots within the quadrant from 3:00 to 6:00 o’clock, the pupil could be moved inferonasally and enlarged to encompass the center of the crystalline lens and at least to or past the diameter shown at 4:30 in the postdilation photo. Since all treatment would be placed 180 degrees away, the superotemporal border of the pupil would move closer to or even perhaps cover the lens equator (which, in Figure 2, appears to be placed inferotemporally rather than temporally. The crystalline lens was clear and without visible phacodonesis, so this treatment modality could preserve accommodation as well as avoid risks related to intraocular surgery. Even if lensectomy were necessary subsequently, iris management would be greatly simplified as a result of the laser procedure. JOEL SHUGAR, MD Perry, Florida, USA REFERENCE 1. Masket S, ed. Consultation section: cataract surgical problem. J Cataract Refract Surg 2004; 30:2035–2049

inclusion criteria had been the same in both groups. There are 2 separate groups in the study. The phakic IOL group had a mean age of 35.7 years (range 32 to 43 years), whereas the CLE group had a mean age of 44.6 years (range 36 to 49 years). Also, the mean preoperative spherical equivalent refractive error was ÿ13.6 G 3.0 diopters (D) in the phakic IOL group and ÿ16.7 G 3.8 D in the CLE group. We think these are distinct groups and cannot be compared with each other. We also think that all the patients should be unilaterally or bilaterally recruited to increase the strength of the study. We would also like to clarify that the implantable contact lens from Staar is hydrophilic acrylic and not hydrophobic acrylic. In the CLE group, a retinal detachment occurred in 2 cases. Both were implanted with a poly(methyl methacrylate) IOL, and a neodymium:YAG (Nd:YAG) capsulotomy was performed to treat posterior capsule opacification. Using modern foldable IOLs with sharp edges results in a lower incidence of PCO and complications following Nd:YAG capsulotomy.1–4 We think it would have been more appropriate if the same foldable IOL had been implanted in all CLE cases. Also, the patients in the CLE group were older and more myopic. Both these preexisting factors are known to predispose to retinal detachment.3,5 Finally, although the author explained the postsurgical satisfaction, the reference on the description of the satisfaction scale is missing. A prospective randomized trial comparing these 2 methods would be more conclusive and desirable. MAYANK A. NANAVATY, DO ABHAY R. VASAVADA, MS, FRCS Ahmedabad, India CHARLOTTA ZETTERSTRO¨M, MD, PHD Stockholm, Sweden REFERENCES 1. Arne JL. Phakic intraocular lens implantation versus clear lens extraction in highly myopic eyes of 30- to 50-year-old patients. J Cataract Refract Surg 2004; 30:2092–2096 2. Hayashi K, Hayashi H, Nakao F, Hayashi F. Changes in posterior capsule opacification after poly(methyl methacrylate), silicone, and acrylic intraocular lens implantation. J Cataract Refract Surg 2001; 27:817–824 3. Jahn CE, Richter J, Jahn AH, et al. Pseudophakic retinal detachment after uneventful phacoemulsification and subsequent neodymium:YAG capsulotomy for capsule opacification. J Cataract Refract Surg 2003; 29:925–929 4. Ranta P, Tommila P, Immonen I, et al. Retinal breaks before and after neodymium:YAG posterior capsulotomy. J Cataract Refract Surg 2000; 26:1190–1197 5. Tielsch JM, Legro MW, Cassard SD, et al. Risk factors for retinal detachment after cataract surgery; a population-based case-control study. Ophthalmology 1996; 103:1537–1545

Phakic IOL implantation versus clear lens extraction in highly myopic eyes

Choroidal neovascularization after LASIK in a patient with low myopia

We appreciate Arne’s idea of comparing phakic intraocular lens (IOL) implantation and clear lens extraction (CLE) in highly myopic eyes.1 However, we would like to comment on a few aspects of the study. The results would have been more conclusive if the

Saeed et al.1 report a single case of choroidal neovascularization (CNV) 3 months after laser in situ keratomileusis (LASIK) for low myopia. After a discussion featuring indefinite terms such

J CATARACT REFRACT SURG - VOL 31, NOVEMBER 2005

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