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Author reply to comment on subconjunctival limbus oblique incision for mature cataracts

Yang, Jun; Lai, Pinghong1,

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Indian Journal of Ophthalmology: April 2015 - Volume 63 - Issue 4 - p 361-362
  • Open


We would like to thank Bayramlar et al. for their comments on our article, “Manual cataract extraction via a subconjunctival limbus oblique incision for mature cataracts.”[1]

  • In the article, we described an incision at the location of 135° for right eyes; however, we use the same location for left eyes.[2] Actually, this incision can be easily performed within the 360° limbus if needed, such as for subluxated lens surgery. For patients with high eyebrows and high bridge of the nose, it can be done in temporal side, facilitated by rotating the head of the patient and adjusting sitting position of the operator. Hence, it's easy to arrange a temporal incision according to corneal curvature meridian direction for correction of preoperative astigmatism
  • A polymethylmethacrylate (PMMA) lens was often used for charge free surgery; however, a foldable lens was also used on demand of the patient. A study by van Gaalen et al. demonstrated that aspheric intraocular lens (IOL) showed less spherical aberration than eyes with PMMA and foldable spherical IOLs, but the differences among the IOLs are small. In addition, eyes with a PMMA IOL showed a larger depth of focus compared to eyes with an aspheric IOL[3]
  • IOL deviation will not occur when a PMMA lens is implanted in the sac with 7 mm capsulorhexis. However, a soft crystal is likely cause IOL deviation when the double loops are not simultaneously located in/out the sac. We use large capsulorhexis combined with anterior capsule polishing techniques to reduce the incidence of postcataract[45]
  • We used to employ the sandwich technique to remove the lens nucleus.[6] However, we found that this technique was not as good as SCOLI for intraoperative eye manipulation when surface topical anesthetization was employed.[2] Moreover, as the author mentioned, a 8 mm nuclear necessitated an 8-9 mm incision with sandwich technique; however, it could pass a 7 mm SCOLI through nuclear deformation. The SCOLI technical are applicable to nucleus of different hardness, including brown and black nuclear. For 9 mm diameter nuclear, the limbal incision is enlarged to 8 mm width, with a conjunctival incision of 6 mm. We also use a 7 mm incision joint with chop technique, removing the lens nucleus at twice.

In short, we thank Bayramlar et al. for their comments on SCOLI technology; we will try our best to improve the cataract surgical techniques.


1. Bayramlar H, Karadag R, Yildirim A, Cakici O, Sari U. Manual tunnel incision cataract surgery with sandwich technique may be a rationale alternative for mature cataracts Indian J Ophthalmol. 2014;62:896–7
2. Yang J, Lai P, Wu D, Long Z. Manual cataract extraction via a subconjunctival limbus oblique incision for mature cataracts Indian J Ophthalmol. 2014;62:274–8
3. van Gaalen KW, Jansonius NM, Koopmans SA, Kooijman AC. Comparison of Optical Performance in Eyes Implanted with Aspheric Foldable, Spherical Foldable, and Rigid PMMA IOLs J Refract Surg. 2011;27:98–105
4. Shah SK, Praveen MR, Kaul A, Vasavada AR, Shah GD, Nihalani BR. Impact of anterior capsule polishing on anterior capsule opacification after cataract surgery: A randomized clinical trial Eye (Lond). 2009;23:1702–6
5. Aykan U, Bilge AH, Karadayi K, Akin T. The effect of capsulorhexis size on development of posterior capsule opacification: Small (4.5 to 5.0 mm) versus large (6.0 to 7.0 mm) Eur J Ophthalmol. 2003;13:541–5
6. Bayramlar H, Cekiç O, Totan Y. Manual tunnel incision extracapsular cataract extraction using the sandwich technique J Cataract Refract Surg. 1999;25:312–5
© 2015 Indian Journal of Ophthalmology | Published by Wolters Kluwer – Medknow