Query to the author of ′comparison of different techniques of cataract surgery in bacterial contamination of the anterior chamber in diabetic and non-diabetic population′

Abstract

Sir, We have read the article published in the current issue of IJO, titled “Comparison of different techniques of cataract surgery in bacterial contamination of the anterior chamber in diabetic and non-diabetic population.”[1] We have the following observations and would like to have author's comments on them. Side port in phacoemulsification surgery is understandable, but irrigation of the anterior chamber using the side port in MSICS indicates that a side port was made in MSICS patients also. However this is not mentioned in the MSICS steps. Kindly clarify, when was that made and the purpose served by the side port. Sub-conjunctival injection at the end of surgery was not given. As we see it, this is a usual practice in cataract surgery that a sub-conjunctival injection of steroid and antibiotics is given just before patching the eye in surgery under local anesthesia. Apart from a depot of antibiotic and steroid, sub-conjunctival injection helps in reposition of the conjunctival flap. Why this deviation from the routine practice? Only an antibiotic solution drop was instilled at the end of surgery. Was there any specific reason for not instilling steroid solution? As mentioned, the eye patch was opened after 6 h of surgery. Again we would consider this as a deviation from routine practice as the dressing is opened on the next day. Any advantage of not giving sub-conjunctival injection of antibiotic steroid solution and then early opening of the eye dressing to start topical medication? Kindly clarify. The eye drop regimen after opening the eye dressing was too aggressive. One hourly instillation of antibiotic steroid eye drop is not justified routinely without any evidence of excessive inflammation or infection. Kindly comment. The antibiotic steroid combination was started at one hourly frequency and later tapered to once daily. It is incorrect to taper the dose of any antibiotic. The antibiotics should be used in adequate dosage and stopped immediately, with no tapering, to prevent emergence of acquired bacterial resistance. Tapering of antibiotics is not justified at all. Author should have used separate antibiotic and steroid drops if they wanted to taper the steroid drop dosage instead of using fixed dose combination of steroid and antibiotic. It is ironical that the authors have condemned the use of antibiotics in irrigating solution for possibility of inducing resistance and at the same time indulged in tapering the dosage of antibiotic eye drop which itself is capable of inducing resistance by exposing the bacteria to sub-minimal lethal dosage.