Repeating a good idea

Abstract

We were interested in the letter from Dr. Michael Lavin1 in reply to our article.2 The letter raises a number of interesting points. The use of iris retractors in the fashion described in our paper demonstrates parallel evolution of surgical technique. We first conceived the technique, which we believed was an original idea, in mid-1996 and performed the first surgery in October 1996. A literature search at that time found no prior referenced publications describing the technique. In a letter about our paper,3 Dr. Robert Mackool mentioned that the technique was reported anecdotally by Dr. John Shepherd at a meeting of the Chicago Ophthalmological Society in May 1993. We were also interested to hear from Dr. Lavin about Dr. Charlotta Zetterström's technique as demonstrated in the Video Journal of Cataract and Refractive Surgery. We can be forgiven for not spotting the report, as on reviewing the descriptions of the contents of this issue it is not obvious that the technique involves the use of iris retractors; the report is entitled “Cataract Surgery Tough Cases—Marfan's Syndrome.” Neither of these reports benefited from medical indexing and so would not be found on a routine literature search. Dr. Lavin states that resterilized iris retractors may have fine irregularities, which can traumatize the intact capsulorhexis. We routinely resterilize these retractors up to 4 times. Currently, these items are not marked as being suitable for single use only. Despite increasing experience using these retractors in this context, we have not noted the complication of trauma to the intact capsulorhexis. We would be interested in knowing whether Dr. Lavin proposes this as a theoretical complication or whether he has actually seen it. We agree there is a problem with the indexing of nonconventional publications. This is particularly true of video media. Internet publications are by their nature indexed, although because of inconsistencies and differences in keyword indexing, less confidence can be placed on negative search results (or time does not allow full examination of the results of wide unspecific searches). However, by publishing the article and as a result of the correspondence generated, the technique is in the medically indexed domain and should reach a wider audience; this is surely the point of the process. We also thank Drs. Merriam and Zheng for their comments in reply to our article and the subsequent correspondence.4 We are at a loss to explain why our literature search did not unearth their excellent article5 and graciously acknowledge their priority. We agree (as I am sure would Dr. Mackool) that a good idea bears repeating and also reporting, and now we have all done both. Philip Bloom FRCS, FRCOphth Vincent Lee MD, FRACS aLondon, United Kingdom