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Letters to the Editor

Authors’ reply

Verma, Neelam; Ram, Jagat; Sukhija, Jaspreet; Pandav, Surinder S; Gupta, Amit

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Indian Journal of Ophthalmology: Jul–Aug 2012 - Volume 60 - Issue 4 - p 335-336
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Dear Editor,

We thank Verma for reading our article[1] with interest. We have not come across any article in literature except a study by Kumar et al.,[2] which prospectively studied the comparison between primary posterior capsulotomy (PPC) and intact capsule in traumatic cataracts in children aged 3–10 years.

  1. We agree with the authors that acrylic foldable lenses result in better outcome compared with polymethyl methacrylate (PMMA).[3] The square edge PMMA intraocular lens (IOL) was chosen for the present study to avoid IOL material variability. Another reason was the affordability factor, as most of them could not afford a foldable IOL due to socioeconomic factors. The variable in this study was PPC. The capsule in traumatic cataract often gets thickened, fibrotic and associated with plaques, and capsular tears involving either or both anterior and posterior capsules can occur. The postoperative inflammation encountered after cataract surgery is greater than that seen after surgery for developmental cataracts.
  2. We agree that PPC in children less than 6 years has become a standard of care.[4] We performed PPC in all cases in group A, in which the mean age was 7.80 years ( range 4–14 years) compared with group B, in which the capsule was left intact, the mean age being 9.87 years (range 4–16 years). In our study, in both the groups, even children more than 8 years developed posterior capsule opacification (PCO). Therefore, we consider that a rigid line of 6 years may not be drawn for performing PPC in traumatic cataracts. In a study by Kumar et al.,[2] the age ranged from 3 to 10 years for performing PPC in one group with traumatic cataract. Although the pathogenesis of PCO in traumatic or developmental cataracts remain similar however children with traumatic cataracts have more propensity for formation of anterior and posterior capsular plaques, thickening more often needing surgical capsulotomy.
  3. The preoperative vision recorded ranged from perception of light to 6/24 in both groups. There were two patients in group A with inaccurate projection at presentation with total cataracts and normal ultrasonography. Their ages at presentation were 5 and 8 years, respectively, and they gained best corrected visual acuity (BCVA) of 6/9 and 6/24, respectively, after cataract surgery.
  4. The interval between injury and surgery ranged from 0.7 to 7 months (average 3.3 ± 2.2 months) in group A and from 0.2 to 25 months (average 4.0 ± 6.5 months) in group B (P = 0.28). Of 13 patients who sustained open globe injury, cataract was removed as a secondary procedure in all patients except in one patient in group B, in which cataract extraction with IOL implantation was done as a combined procedure with corneal repair. The reason for performing surgery as early as 0.2 months was presence of freely floating cortical matter in the anterior chamber. One patient (15 years of age at presentation) who underwent cataract surgery after 25 months of blunt trauma had presenting vision of counting finger and gained BCVA of 6/24 after cataract surgery and 6/9 after Nd:YAG capsulotomy.
1. Verma N, Ram J, Sukhija J, Pandav SS, Gupta A. Outcome of in-the-bag implanted square-edge polymethyl methacrylate intraocular lenses with and without primary posterior capsulotomy in pediatric traumatic cataract Indian J Ophthalmol. 2011;59:347–51
2. Kumar S, Panda A, Badhu BP, Das H. Safety of primary intraocular lens insertion in unilateral childhood traumatic cataract J Nepal Med Assoc. 2008;47:179–85
3. Rowe NA, Biswas S, Lloyd IC. Primary IOL implantation in children: A risk analysis of foldable acrylic v PMMA lenses Br J Ophthalmol. 2004;88:481–5
4. Ram J, Gupta N, Sukhija J, Chaudhary M, Verma N, Severia S. Outcome of cataract surgery with primary intraocular lens implantation in children Br J Ophthalmol. 2011;95:1086–90
© 2012 Indian Journal of Ophthalmology | Published by Wolters Kluwer – Medknow