819LETTERS

4. Steijns D, Bijlsma WR, Van der Lelij A. Cataract surgery in pa-

tients with nanophthalmos. Ophthalmology 2013; 120:266–270

5. Yuzbasioglu E, Artunay O, Agachan A, Bilen H. Phacoemulsifica-

tion in patients with nanophthalmos. Can J Ophthalmol 2009;

44:534–539. Available at: http://www.eyesite.ca/CJO/4405/i09-

142.pdf. Accessed March 1, 2013

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phthalmos. Arch Ophthalmol 1989; 107:1625–1630

7. Faucher A, HasaneeK, RootmanDS.Phacoemulsification and in-

traocular lens implantation in nanophthalmic eyes; report of a me-

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8. Duke-Elder S. Anomalies in the size of the eye. In: Duke-Elder S,

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ton, 1964; 488–495

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Evaluation of inflammation and intraocularpressure after cataract surgery

Lane and Holland1 have rightly compared 2 medi-cations, loteprednol etabonate 0.5% and prednisoloneacetate 1.0%, after cataract surgery. However, wewould like to make a few observations.

The intraocular pressure (IOP) after cataract surgeryis affected by preoperative levels, the retained ophthal-mic viscosurgical device (OVD), and the central cor-neal thickness (CCT). We know that CCT increasesafter phacoemulsification and recovers over time.2

Based on this knowledge, it is clear that postoperativecorrected IOP is different from the uncorrected IOP. Inthe current study, we do not know that the CCT in-crease was the same in the 2 groups. The preoperativeCCT level, effective phaco time, surgical time, use ofOVD, and many other factors may affect the increasein CCT and its course. In addition, the amount ofretained OVD can vary in multicenter studies. In theearly postoperative period, the retained OVD mayaffect the IOP. The elevation of IOP due to OVD ismarked at 6 to 24 hours,3 and the effect of OVD onIOP may take up to 72 hours.4 Therefore, we thinkevaluating corrected IOP early postoperatively andthen 24 to 48 hours later will providemore clear resultsabout the efficacy of loteprednol etabonate 0.5% andprednisolone acetate 1.0% on IOP changes.

J CATARACT REFRACT SURG

Another point that we want to share is the relation-ship of anterior chamber cell and flare intensity to thepatient's visual acuity, satisfaction, and comfort. Al-though statistically insignificant results or negligibledifferences between the 2 medications were reported,we have experienced red eye, sensitivity to light,and, rarely, fibrin reactionwhen loteprednol etabonate0.5% was used as an initial treatment after cataractsurgery. In these unfortunate conditions, patients areconcerned about the success of the cataract surgery.

In our practice, if the surgery is uneventful or pa-tients have no glaucoma, we use prednisolone acetate1.0% 4 times daily for 1 week, 3 times daily for thesecond week, and 2 times daily for 2 weeks. Inglaucomatous eyes, in addition to antiglaucomatousmedication, we use prednisolone acetate 1.0% 4 timesdaily for a week and then loteprednol etabonate 0.5%4 times for the second week and 2 times for the next2 weeks. In this manner, we use the advantages ofthese medications rather than their disadvantages.

Erhan €Ozyol, MDPelin €Ozyol, MD

Ordu, Turkey

REFERENCES1. Lane SS, Holland EJ. Loteprednol etabonate 0.5% versus

prednisolone acetate 1.0% for the treatment of inflammation

after cataract surgery. J Cataract Refract Surg 2013; 39:168–173

2. Kandarakis A, Soumplis V, Karampelas M, Koutroumanos I,

Panos C, Kandarakis S, Karagiannis D. Response of corneal

hysteresis and central corneal thickness following clear corneal

cataract surgery. Acta Ophthalmol 2012; 90:526–529

3. Dada VK, Sindhu N, Sachdev MS. Postoperative intraocular

pressure changes with use of different viscoelastics. Ophthalmic

Surg 1994; 25:540–544

4. LarsonRS, LindstromRL, Skelnik DL. Viscoelastic agents. CLAO

J 1989; 15:151–160

Reply : Drs. Erhan and Pelin €Ozyol are correct thatour study did not “correct” for IOP, and we also agreethat IOP is dependent on the many factors mentionedin their letter. Although a “corrected” IOPmay indeedgive a more accurate representation of the magnitudeof the pressure, our study looked at the delta or changein pressure from baseline, specifically looking at morelong-term IOP changes that might indicate a greatersteroid response in one group than in the other.1,2

Postoperative short-term IOP changes (less than 1week) could indicate surgical factors such as changesin CCT due to edema, but longer-term IOP changeswould not. It is a reasonable assumption that postop-erative CCT will be similar to baseline (there were nocases of clinical corneal edema) by day 21 and assuch would be an accurate representation of changein IOP. Furthermore, it has been shown that in more

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