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We thank Mataftsi and associates for their interest in our article. 1 Shenoy B.H. Mittal V. Gupta A. Sachdeva V. Kekunnaya R. Complications and visual outcomes after secondary intraocular lens implantation in children. Am J Ophthalmol. 2015; 159: 720-726 Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar We agree with the authors that usage of a polymethyl methacrylate (PMMA) intraocular lens (IOL) has many drawback and hence is not the first choice of IOL to be used in children. However, after the hydrophobic acrylic IOLs, these are the second most preferred IOLs in children. In our study a high number of PMMA lens implantations could be attributed to the fact that the study involved children operated over a decade, from January 1, 2000 to December 31, 2010, when the PMMA IOLs were still very prevalent. In addition, in the patients who could not afford the hydrophobic acrylic lenses, PMMA IOLs were chosen. Currently we prefer a 3-piece or single-piece hydrophobic acrylic foldable IOL in children undergoing secondary/primary IOL implantation. However, in children undergoing secondary IOL implantation in sulcus, PMMA IOLs also have an advantage over single-piece hydrophobic IOLs in terms of greater stability and less iritis and pigment dispersion. Complications and Visual Outcomes After Secondary Intraocular Lens Implantation in ChildrenAmerican Journal of OphthalmologyVol. 160Issue 5PreviewWe read with great interest the article entitled “Complications and visual outcomes after secondary intraocular lens implantation in children”1 and would like to congratulate Shenoy and associates on their excellent work. This is the largest series so far reported of secondarily implanted aphakic children, and in 81% of them (ie, in 141 eyes) a polymethyl methacrylate (PMMA) lens was implanted in the sulcus. Even though a scleral tunnel was constructed in most cases (66%), insertion of a rigid PMMA lens requires a large incision, so one would expect a considerable amount of postoperative astigmatism. Full-Text PDF