288 Indian Journal of Ophthalmology Vol. 63 No. 3 with only topical steroids. We also apply only topical steroids
after the standard phacoemulsification surgery instead of intracameral steroid injection.
Sirel Gür Güngör, Begüm Bulam,
Ahmet Akman, Meriç Çolak
1Department of Ophthalmology, Faculty of Medicine, Başkent University, 1Department of Health Care Management,
Faculty of Medicine, Başkent University, Ankara, Turkey Correspondence to: Dr. Sirel Gür Güngör, Department of Ophthalmology, Faculty of Medicine, Başkent University, Fevzi Çakmak Caddesi, Bahçelievler, 06490 Ankara, Turkey. E-mail: sirelgur@yahoo.com
References
1. Gungor SG, Bulam B, Akman A, Colak M. Comparison of intracameral dexamethasone and intracameral triamcinolone acetonide injection at the end of phacoemulsification surgery. Indian J Ophthalmol 2014;62:861-4.
2. Karalezli A, Borazan M, Akova YA. Intracameral triamcinolone acetonide to control postoperative inflammation following cataract surgery with phacoemulsification. Acta Ophthalmol 2008;86:183-7. 3. Gills JP, Gills P. Effect of intracameral triamcinolone to control
inflammation following cataract surgery. J Cataract Refract Surg 2005;31:1670-1.
4. Chang DT, Herceg MC, Bilonick RA, Camejo L, Schuman JS, Noecker RJ. Intracameral dexamethasone reduces inflammation on the first postoperative day after cataract surgery in eyes with and without glaucoma. Clin Ophthalmol 2009;3:345-55.
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Respond to: Assessment of central
corneal thickness and intraocular
pressure in premature and full-term
newborns
Dear Sir,
We did not evaluate the different variables such as corneal astigmatism, refractive error and axial length took in account in intraocular pressure (IOP) assessment.
If this study is done, more patients separated into groups according to the gestational age can be demonstrated by the effect of gestational age on IOP and corneal thickness.[1]
Isil Bahar Sayman Muslubas, Ayse Yesim Aydın Oral
1,
Cemalettin Cabi
2, Sinan Caliskan
3Semdinli State Hospital, Hakkari, 1Dr. Lütfi Kirdar Kartal Training and
Research Hospital, Istanbul, 2Sinop State Hospital, Sinop, 3Van Training
and Research Hospital, Van, Turkey Correspondence to: Dr. Isil Bahar Sayman Muslubas,
Semdinli State Hospital, Hakkari, Turkey. E-mail: isil_sayman@hotmail.com
Reference
1. Muslubas IB, Oral AY, Cabi C, Caliskan S. Assessment of the central corneal thickness and intraocular pressure in premature and full-term newborns. Indian J Ophthalmol 2014;62:561-4.
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DOI:
10.4103/0301-4738.156951
PMID:
***
Evaluation of anterior chamber
inflammation
Dear Sir,
We read the article ‘‘comparison of intracameral dexamethasone and intracameral triamcinolone acetonide injection at the end of phacoemulsification surgery” by Gungor et al. With a great interest.[1] The authors aimed to compare the results of
intracameral dexamethasone and intracameral triamcinolone acetonide injection in patients that underwent cataract surgery with phacoemulsification. And they concluded that these two treatment modalities were similarly effective in controlling postoperative inflammation following phacoemulsification. However, the intraocular pressures (IOPs) on postoperative 1st day were higher in patients receiving intracameral
triamcinolone acetonide. Therefore using intracameral dexamethasone seemed to be a better alternative to apply at the end of surgery to suppress the inflammation during the first 24 h. We congratulate the authors for their lightening study about an actual subject and would like to make some contributions and criticism about study.
The authors used the slit lamp technique to evaluate the anterior chamber inflammation. The thickness and height of the slit light were 0.5 mm × 8 mm. A standardization of grading anterior chamber cell and flare level is important for reporting clinical data and scientific communication. In literature there are commonly used a few grading methods such as scale of Hogan et al. and scale of Standardization of Uveitis Nomenclature working group.[2] Measures of the slit
light was 1 mm × 1 mm in both of these scales. Only count of the cells in each grade was a little bit different from each other. The measures of the slit light used in this study were different from these two accepted scale and this may change the results. On the other hand, slit lamp technique is a subjective method and has some limitations. If anterior chamber is flue due to reasons other than cell and flare it will be very difficult to determine the cell count and flare level correctly. Hence, it can be much more difficult, especially in a triamcinolone acetonide injected anterior chamber.
March 2015 Letters to the Editor 289 Laser flare/cell meter is an alternative quantitative method
to measure intraocular inflammation and has been reported to be superior to slit lamp flare and slit lamp cells to assess and monitor anterior chamber inflammation.[3] On the other
hand, this measurement method does not look suitable for triamcinolone acetonide injected anterior chambers. Because this technique measures all particles in aqueous containing triamcinolone acetonide crystals. Another way of evaluating anterior chamber inflammation is measuring the level of inflammatory mediators such as prostaglandin E2, tumor necrosis factor, nitric oxide, interleukin-8 (IL-8), IL-9, IL-10, IL-12, interferon gamma (IFN-α), IFN-γ in aqueous sample. This alternative way of detecting anterior chamber inflammation could be a better choice in triamcinolone acetonide injected patients.[4]
Intraocular pressure is a dynamic parameter with a circadian rhythm and has fluctuations. It’s commonly measured higher in night time (2–4 a.m.) and lesser in day time (2–4 p.m.). The average IOP difference between night time and day time is 4–5 mmHg.[5] In this study, the authors did not inform when
IOP measurements were performed. Hence, this may change the results also.
Yakup Aksoy, Taner Kar
1, Kadir Çolakoğlu
2Department of Ophthalmology, Hakkari Military Hospital, Hakkari,
1Department of Ophthalmology, GATA Haydarpasa Training Hospital, 2Department of Ophthalmology, Kasımpasa Military Hospital,
Istanbul, Turkey Correspondence to: Dr. Yakup Aksoy, Department of Ophthalmology, Hakkari Military Hospital, Hakkari, Turkey. E-mail: dryakupaksoy@gmail.com
References
1. Gungor SG, Bulam B, Akman A, Colak M. Comparison of intracameral dexamethasone and intracameral triamcinolone acetonide injection at the end of phacoemulsification surgery. Indian J Ophthalmol 2014;62:861-4.
2. Jabs DA, Nussenblatt RB, Rosenbaum JT, Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the first international workshop. Am J Ophthalmol 2005;140:509-16. 3. Gupta V, Gupta A. Ancillary investigations in uveitis. Indian J
Ophthalmol 2013;61:263-8.
4. Chua J, Vania M, Cheung CM, Ang M, Chee SP, Yang H, et al. Expression profile of inflammatory cytokines in aqueous from glaucomatous eyes. Mol Vis 2012;18:431-8.
5. Sihota R, Saxena R, Gogoi M, Sood A, Gulati V, Pandey RM. A comparison of the circadian rhythm of intraocular pressure in primary phronic angle closure glaucoma, primary open angle glaucoma and normal eyes. Indian J Ophthalmol 2005;53:243-7.
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www.ijo.in DOI: 10.4103/0301-4738.156952 PMID: ***
Authors' reply
Dear Sir,We were happy to receive the letter concerning our article titled ‘‘comparison of intracameral dexamethasone and intracameral triamcinolone acetonide (TA) injection at the end of phacoemulsification surgery”.[1] In this study, we
aimed to compare the results of intracameral dexamethasone and intracameral TA injection in patients that underwent phacoemulsification surgery. This study demonstrated that intracameral dexamethasone and intracameral TA were similar effective in controlling postoperative inflammation after uncomplicated cataract surgery with phacoemulsification. However, the intraocular pressures (IOP) on postoperative 1st day were higher in patients receiving intracameral TA. Since
the highest IOP in the TA group was 24 mmHg and stabilized in a few days, in practical terms, using TA may impose a minimal risk to patients. This increase in IOP may be important in a patient with glaucoma.
The author suggested that the scale of Standardization of Uveitis Nomenclature (SUN) working group is a commonly used method, and measures of the slit light were 1 mm × 1 mm in this scale.[2] In this study, anterior chamber
cell and flare scores were determined using the narrowest slit beam (0.5 mm) at a height of 8 mm, with maximal luminance and magnification of the slit-lamp. In previous studies, which took place in our clinic, we used this method in measuring anterior chamber cell and flare,[3] but surely the method
which was suggested by the authors could have been used. Unfortunately, at the time of the study, the anterior chamber flare cell meter was not available in our clinic, and hence we used slit‑lamp biomicroscopy to investigate the anterior chamber cells and flare. We stated that is the limitation factor of the study. Along with that, injection of TA into the anterior chamber resulted in a “snow-globe effect” of various densities at slit-lamp examination. Despite the suspension of TA crystals, it was easy to assess cell and flare between crystals. The author also suggested, another way of evaluating anterior chamber inflammation is measuring the level of inflammatory mediators in aqueous sample. This suggestion might be used in future studies.
Another important point criticized by the author is that IOP is a dynamic parameter with a circadian rhythm and has fluctuations. Because of that, all preoperative and postoperative measurements were conducted between 8 a.m. and 9 a.m in this study.
Sirel Gür Güngör
Department of Ophthalmology, Faculty of Medicine, Başkent University, Ankara, Turkey Correspondence to: Dr. Sirel Gür Güngör, Department of Ophthalmology, Faculty of Medicine, Başkent University, Ankara, Turkey. E-mail: sirelgur@yahoo.com
References
1. Gungor SG, Bulam B, Akman A, Colak M. Comparison of intracameral dexamethasone and intracameral triamcinolone
