Reply : Journal of Cataract & Refractive Surgery

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Dewey, Steven MD; Beiko, George BM BCh, FRCSC; Braga-Mela, Rosa MD, MEd, FRCSC; Nixon, Donald R. MD, FRCSC, DABO; Raviv, Tal MD, FACS; Rosenthal, Kenneth MD

Journal of Cataract & Refractive Surgery 41(2):p 480, February 2015. | DOI: 10.1016/j.jcrs.2014.12.037
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We would like to apologize to Dr. Alió if he was offended that his work was not cited in our review article. There was certainly no purposeful intent on the part of the authors to exclude his work from our review nor to neglect his contributions to the field. Rather, our work was intended as a brief review of the existing technologies and, therefore, inevitably some concision was necessary.

Dr. Alió makes a point regarding the term microincisional cataract surgery for which he registered a trademark within the EU in 2003. This trademark is not registered in the United States nor would it qualify since the abbreviation MICS bears the same meaning as the underlying generic phrase. The use of sub-1.0 mm incisions a decade ago to remove the cataract was indeed revolutionary. However, our review refers to the current vernacular, describing an incision associated with coaxial phacoemulsification of 2.4 mm or smaller.

While work with sleeveless biaxial phacoemulsification has been invaluable to our understanding of coaxial phaco, we thought that since it is a procedure performed by a minority of surgeons (including several of the authors), it did not warrant an expanded discussion. To Dr. Alió, I offer this: We are still hindered by the final incision size required for safe IOL implantation, particularly on this side of the Atlantic.

We disagree that the omission in any way negates the validity of the article. Rather, it summarizes the current validity of using 2.4 mm incisions or smaller with coaxial phacoemulsification in safely delivering outstanding visual results for our patients.

For those interested in biaxial phacoemulsification, Klonowski et al.’s1 excellent review article does outline and explain the steps needed to transition from a coaxial procedure to biaxial.


1. Klonowski P, Rejdak R, Alió JL. Microincision cataract surgery: 1.8 mm incisional surgery. Expert Rev Ophthalmol. 2013;8:375-391.
© 2015 by Lippincott Williams & Wilkins, Inc.