Author reply

Abstract

We are pleased that our paper has interested readers, and we thank our colleagues Dr. Murat Uyar and Vedat Kaya for their valuable comments. We largely agree with their views about the high complication rates of intraocular lens (IOL) implantation during infancy and the possible role of a variety of factors implicated in the pathogenesis of IOL opacification. Also their experience of similar cases is interesting.Uyar et al raise 2 issues: First, they ask if any such problems were noted with hydrophobic IOLs. We have not observed similar opacification in any of the 19 infants with hydrophobic intraocular lenses that are on clinical follow up for last 18 months (unpublished data). We do see pigment deposits quite commonly on these IOLs, but these do not seem to affect the clarity of the visual axis. These are quite different from the opacification observed in the reported cases with hydrophilic lenses.Second, Uyar and Kaya ask was opacification seen in hydrophilic IOLs, which were implanted in the capsular bag? In our experience of 25 hydrophilic IOLs implanted in the bag (unpublished data), 2 lenses developed opacification as described in our paper1Pehere N.K. Bojja S. Vemuganti G.K. et al.Opacification of intraocular lenses implanted during infancy: a clinicopathologic study of 4 explanted intraocular lenses.Ophthalmology. 2011; 118: 2128-2132Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar (one case had fine deposits and another had dense opacification obscuring the fundus glow).We believe that our experience with hydrophilic lenses and the comments reported in this letter highlight the need for carefully designed experiments to look at various factors proposed to be involved in the pathogenesis of such opacification.We also agree with our colleagues that IOL implantation itself in infancy is controversial, and more experience with IOLs and their placement need to be studied. All pediatric cataract surgeons should meticulously document all adverse events, study them in detail and report the outcomes. This collective experience from around the world would give a much better idea about the safety of IOL implantation in this age group. We are pleased that our paper has interested readers, and we thank our colleagues Dr. Murat Uyar and Vedat Kaya for their valuable comments. We largely agree with their views about the high complication rates of intraocular lens (IOL) implantation during infancy and the possible role of a variety of factors implicated in the pathogenesis of IOL opacification. Also their experience of similar cases is interesting. Uyar et al raise 2 issues: First, they ask if any such problems were noted with hydrophobic IOLs. We have not observed similar opacification in any of the 19 infants with hydrophobic intraocular lenses that are on clinical follow up for last 18 months (unpublished data). We do see pigment deposits quite commonly on these IOLs, but these do not seem to affect the clarity of the visual axis. These are quite different from the opacification observed in the reported cases with hydrophilic lenses. Second, Uyar and Kaya ask was opacification seen in hydrophilic IOLs, which were implanted in the capsular bag? In our experience of 25 hydrophilic IOLs implanted in the bag (unpublished data), 2 lenses developed opacification as described in our paper1Pehere N.K. Bojja S. Vemuganti G.K. et al.Opacification of intraocular lenses implanted during infancy: a clinicopathologic study of 4 explanted intraocular lenses.Ophthalmology. 2011; 118: 2128-2132Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar (one case had fine deposits and another had dense opacification obscuring the fundus glow). We believe that our experience with hydrophilic lenses and the comments reported in this letter highlight the need for carefully designed experiments to look at various factors proposed to be involved in the pathogenesis of such opacification. We also agree with our colleagues that IOL implantation itself in infancy is controversial, and more experience with IOLs and their placement need to be studied. All pediatric cataract surgeons should meticulously document all adverse events, study them in detail and report the outcomes. This collective experience from around the world would give a much better idea about the safety of IOL implantation in this age group. Pediatric IOL OpacificationOphthalmologyVol. 119Issue 8PreviewWe have some comments on the article, “Opacification of intraocular lenses implanted during infancy: a clinicopathologic study of 4 explanted intraocular lenses.”1 Opacification of intraocular lenses (IOLs) after implantation can be related to various factors including the IOL manufacturing process, IOL storage, adjuvants used during surgery, surgical techniques,2 and patient-associated conditions, mainly postoperative inflammation more or less as reported in this case series. The authors report the fish-egg appearance as a novel finding in this study. Full-Text PDF