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LETTER TO THE EDITOR
Year : 2020  |  Volume : 32  |  Issue : 3  |  Page : 331-332

Comment on ' Comparison of the scleral tunnel constructed with crescent versus razor blade using the anterior segment optical coherence tomography”


Department of Cataract, Cornea and Refractive Services-Bharat Gurnani; Department of Pediatric and Squint Services-Kirandeep, Aravind Eye Hospital, Puducherry, India

Date of Submission29-Aug-2020
Date of Acceptance01-Sep-2020
Date of Web Publication23-Dec-2020

Correspondence Address:
Dr. Bharat Gurnani
Aravind Eye Hospital, Thavalakuppam, Cuddalore main road, Pondicherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kjo.kjo_130_20

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How to cite this article:
Kaur K, Gurnani B. Comment on ' Comparison of the scleral tunnel constructed with crescent versus razor blade using the anterior segment optical coherence tomography”. Kerala J Ophthalmol 2020;32:331-2

How to cite this URL:
Kaur K, Gurnani B. Comment on ' Comparison of the scleral tunnel constructed with crescent versus razor blade using the anterior segment optical coherence tomography”. Kerala J Ophthalmol [serial online] 2020 [cited 2021 Apr 22];32:331-2. Available from: http://www.kjophthal.com/text.asp?2020/32/3/331/304543



Dear Sir,

We agree that manual small-incision cataract surgery (MSICS) has emerged as the most relied surgery for cataract in developing countries like India.[1] MSICS has come a long way, with self-sealing wounds, capsulorhexis, and in the bag placement of intraocular lens.[2] We read the article by Murthy and Sudhakar[3] with great interest, and we would like to congratulate the authors for bringing out this novel study.

However, we have some important observations, and we would like the authors to throw light on these. First, in the abstract, one case of premature entry has been mentioned, and the same has not been highlighted in the result section. It would be great if authors can give details of this. It will be good to know how much was the baseline incision length constructed.

Second, the tunnel construction has been described with blade versus crescent. As per the conventional teaching, angulated instruments (such as the crescent knife and keratome) are used for MSICS triplanar wound construction. In the study, the authors have described scleral tunnels using razor blade, which is a much sharper and straight instrument. The same has been described in literature.[4] We would like to know if this is regularly followed for routine cases and how they fashioned self-sealing incisions with the straight blade. Moreover, the blade being a sharp instrument might be associated with higher complication rates of premature entries and Descemet membrane detachment (DMD). It will be great if authors can share their experience and challenges faced, especially in young, less experienced hands.

It is an interesting finding that the time taken to construct tunnels with a crescent knife (32.9 s) was more as compared to that of a blade (27.3 s). It would be interesting to know how standardization was done for recording the time accurately.

The authors have mentioned that tunnels made with blade were deeper as compared to crescent. It will be good to have details about the depth of tunnel in the cases that required suturing or if any intraoperative positive pressure or iris prolapse was experienced in these cases. This can help in enhancing the understanding of readers that suturing was required because of problem with depth or because of inadequate tunnel width (measured from the scleral incision to the corneal entry point), if this was measured.

It will also be good if the authors can highlight details of the patient who had DMD. The details of the depth of external and internal tunnel in this case will be very important. It would be great to know that DMD was detected intraoperatively or was diagnosed on the postoperative day 1, based on ocular coherence tomography.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gogate PM, Deshpande M, Wormald RP. Is manual small incision cataract surgery affordable in the developing countries? A cost comparison with extracapsular cataract extraction. Br J Ophthalmol 2003;87:843-6.  Back to cited text no. 1
    
2.
Gurung R, Hennig A. Small incision cataract surgery: tips for avoiding surgical complications. Community Eye Health 2008;21:4-5.  Back to cited text no. 2
    
3.
Murthy SR, Sudhakar P. Comparison of the scleral tunnel constructed with crescent versus razor blade using the anterior segment optical coherence tomography. Kerala J Ophthalmol 2020;32:166-70.  Back to cited text no. 3
  [Full text]  
4.
Olu ME. Wound geometry as it relates to tunnel valvular competence in manual small incision cataract surgery. Niger J Ophthalmol 2014;22:1-6.  Back to cited text no. 4
  [Full text]  




 

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