Comment on: “Phacoemulsification in patients with corneal opacities using slit illumination of the surgical microscope.”

Abstract

Comment on: Phacoemulsification in patients with corneal opacities using slit illumination of the surgical microscope We read the article by Rateb et al. and appreciate the authors for their innovative idea to mitigate the challenging surgical situation. 1 During the phacoemulsification procedure, corneal clarity and stereoscopic visibility without any aberration and glare are crucial because the surgical steps are precise, delicate, and must be performed in a small space with powerful energy without inducing any collateral damage to the surrounding ocular tissues, particularly to the delicate cornea. In our experience, not only the grade but also the size and anatomical location of the corneal opacity are the determinants. Relevant information such as the width of the slit beam, the intensity of illumination, and the magnification of the surgical microscope, various phacoemulsification parameters, dissipated ultrasound energy, preoperative and postoperative endothelial cell count, preoperative and postoperative anterior segment optical coherence tomography findings, and any intraoperative difficulties encountered would have given the readers more insight. All these findings are important in reference to short-term and long-term postoperative outcome and to evaluate the safety and efficacy of the technique. If all the information is available, it will be beneficial for the authors to consider publishing it.We also wish to know the indication for using trypan blue dye. Was it only to stain the anterior capsule to negotiate the corneal haze? Yuksel conducted a similar study in patients with corneal opacity using trypan blue dye and an intracameral endoilluminator to increase visibility of the anterior capsule. 2 In the study, 0.6% trypan blue was used. Did it make any difference with 0.1% trypan blue as it was used in the study by Rateb et al.? A comparative study between all the techniques described to perform successful phacoemulsification surgery in coexisting corneal opacity will throw more light on the particular issue. We again congratulate the authors for their innovative idea, which will add value to scientific literature.