We appreciate the comments that we received on our last review entitled “New insights into cataract surgery in patients with uveitis.” Dr. Gandhi raised an important point in his reply highlighting the importance of looking toward those patients in a very critical manner. In our review, we emphasized on the importance of controlling inflammation before any intraocular intervention. We totally agree on the importance of having the appropriate surgical instruments in the operating theater to overcome any challenges. Although it is interesting maneuver to dissect posterior synechiae by performing a peripheral iridotomy (PI), this technique may be associated with intraoperative hyphema and postoperative glare/diplopia. However, we use a similar approach when the patient already had PI.
“However easy or however difficult the surgery, the threat of a complication is always present, and, as surgery become arduous, the surgeon must diligently address those factors that may destabilise the operation. Possession of the right instruments is one such factor, and, to echo a recent paper, there should be micrograspers and microscissors to hand when operating on uveitic cataract.” We agree that using scissors, needles, or even diathermy may be needed in cases of calcified fibrosed anterior capsule. Good size capsulorhexis, careful polishing of capsule, and, in selected cases, using capsular tension rings are important measures to prevent capsular shrinking.
Although uveitic cataracts are more surgically demanding due to pupil abnormalities that limit access to the cataract, various surgical techniques can be applied to ensure successful cataract surgery. Thus, meticulous planning of any surgical intervention on case-by-case basis is very crucial to ensure good outcomes in those patients.
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Conflicts of interest
There are no conflicts of interest.
1. Al-Essa RS, Alfawaz AM. New insights into cataract surgery in patients with uveitis: A detailed review of the current literature Saudi J Ophthalmol. 2022;36:133–41