Sir,
We thank Dr Sandhu and Dr Clarke for their correspondence in regard to our paper on the safety and stability of the MA50 intraocular lens when placed in the sulcus.1
In addressing the angle morphology of patients without optic capture of the intraocular lens in which ocular hypertension, glaucoma or iritis was observed, none were diagnosed with pigment dispersion syndrome based on clinical characteristics. Of the eight patients, three had iritis, one had iritis and open angle glaucoma, one had ocular hypertension alone, one had steroid-induced ocular hypertension, one had neovascular glaucoma secondary to proliferative diabetic retinopathy, and one had normal tension glaucoma. Three of these eight patients had documented gonioscopy. In cases in which gonioscopy was not performed, bilaterality, clinical suspicion, and clinical course indicated a non-pigmentary cause, although we agree that gonioscopy would be prudent to do in all cases in the future.
We agree with Drs Sandhu and Clarke about the importance of counseling patients regarding the risk of pigmentary glaucoma found in other studies.2 Specifically, our study had a median follow-up of 12.5 months, whereas Chang et al2 reported an average onset of glaucoma after 21.9±17.1 months.
We are grateful to Dr Sandhu and Dr Clarke for their comments and emphasis on the importance of optic capture and its apparent benefit in reducing morbidity following sulcus placement of the MA50 intraocular lens.
References
Kemp PS, Oetting TA . Stability and safety of MA50 intraocular lens placed in the sulcus. Eye (Lond) 2015; 29 (11): 1438–1441.
Chang SH, Wu WC, Wu SC . Late-onset secondary pigmentary glaucoma following foldable intraocular lenses implantation in the ciliary sulcus: a long-term follow-up study. BMC Ophthalmol 2013; 13: 22.
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Kemp, P., Oetting, T. Response to Dr Sandhu and Dr Clarke. Eye 30, 1397–1398 (2016). https://doi.org/10.1038/eye.2016.92
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DOI: https://doi.org/10.1038/eye.2016.92