The article by Dr. Saraf describing cases of late uveitis after phacoemulsification was interesting. The possible role of retained lens matter, viscoelastic and metallic dust from the phaco tip have been emphasised. However, certain points need to be clarified.
Same preoperative and postoperative medicines were used for all cases; was the viscoelastic agent the same too? Was there any possibility of cluster depending upon the use of same batch of the viscoelastic or any difference in the method of storage? The viscoelastic was not washed from the capsular bag behind the IOL; a variable retained amount (the situation more compounded if the viscoelastic was not the same in all cases) could cause variable inflammatory reaction in different cases postoperatively. Variable tissue handling during surgery (due to variable pupillary dilatation, etc.) could also be partly responsible.
In the postoperative period, only betamethasone eye drops were used routinely (without any topical antibiotic, one presumes). As a result, the possibility of low grade infective component could not be ruled out, especially when aqueous fluid or material from capsular bag was not cultured in any case. No comment was available on the capsular deposits either, while describing the clinical pictures postoperatively. Suppressing the inflammatory component only, with topical corticosteroids, in a situation of low grade infection could partly explain the recurrent or chronic nature of the problem.
The possible role of debris in the phacoemulsification handsets should also be kept in mind to explain postoperative uveitis, as we have started realising recently.
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Conflict of Interest:
1. Saraf PK. Late recurrent uveitis after phacoemulsification Indian J Ophthalmol. 2004;52:158–59
2. Posenauer B, Funk J. Chronic postoperative endophthalmitis caused by Propionibacterium acnes Eur J Ophthalmol. 1992;2:94–97
3. Leslie T, Aitken DA, Barrie T, Kirkness CM. Residual debris as a potential cause of post phacoemulsification endophthalmitis Eye. 2003;17:506–12