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LETTERS

scrutiny should be applied to the suggested significance of the efficacy of intracameral cefuroxime. Sarah C. Williams, MB BCh Chris H.L. Lim, BSc(Med) Hons, BMed, MD Felicia A. Aulia, BMed Steven T.H. Yun, MB BS BSc Ravjit Singh, BMed, MD Zachary E. McPherson, BSc Ashish Agar, FRANZCO, PhD Ian C. Francis, FASOPRS, PhD Sydney, Australia

true in aphakic eyes after anterior vitrectomy has been done during complicated cataract surgery. The maneuver of creating an iridotomy with the MVR blade tends to push the iris posteriorly without cutting through the iris tissue, especially in thick brown irides. Therefore, it is imperative that the iridotomy be made as peripherally as possible and that a sharp MVR blade be used to prevent iatrogenic iridodialysis. Vinod Kumar, MS, DNB, MNAMS, FRCS(Glasg) Bhuvan Chanana, MD, DNB New Delhi, India

REFERENCES  enz MC, Villar-del-Campo MC, 1. Rodrıguez-Caravaca G, Garcıa-Sa s-Alba Y, Arias-Puente A. Incidence of endophthalmitis and Andre impact of prophylaxis with cefuroxime on cataract surgery. J Cataract Refract Surg 2013; 39:1399–1403 2. Taban M, Behrens A, Newcomb RL, Nobe MY, Saedi G, Sweet PM, McDonnell PJ. Acute endophthalmitis following cataract surgery; a systematic review of the literature. Arch Ophthalmol 2005; 123:613–620. Available at: http://archopht.jama network.com/data/Journals/OPHTH/9940/ecs40117.pdf. Accessed January 29, 2014 3. Francis IC, Roufas A, Figueira EC, Pandya VB, Bhardwaj G, Chui J. Endophthalmitis following cataract surgery: the sucking corneal wound. J Cataract Refract Surg 2009; 35:1643–1645 4. Olson RJ. Reducing the risk of postoperative endophthalmitis. Surv Ophthalmol 2004; 49(suppl 2):S55–S61 5. Ku JJ, Wei MC, Amjadi S, Montfort JM, Singh R, Francis IC. Role of adequate wound closure in preventing acute postoperative bacterial endophthalmitis [letter]. J Cataract Refract Surg 2012; 38:1301–1302; reply by M Packer, DF Chang, SH Dewey, BC Little, N Mamalis, TA Oetting, A Talley-Rostov, SH Yoo, 1302

Comments on surgical iridotomy technique We congratulate Athanasiadis et al.1 for documenting the surgical iridotomy technique. We have used this technique in several clinical scenarios and have a few observations to make. One advantage of the technique is the ease of placing an iridotomy in the superior iris so it is covered by the upper lid. A large number of modern cataract surgeries are performed using a temporal clear corneal section. It is virtually impossible to make a superior iridectomy using a scissors in this situation. It is cosmetically as well as optically undesirable to place an iridotomy in the temporal iris. When the main section is at the temporal limbus, one can easily use the side port (used for the second instrument) in the case of the right eye to create an iridotomy. In the left eye, a paracentesis can be created at the superior limbus to make an iridotomy with the microvitreoretinal (MVR) blade. However, as opposed to the other methods of surgical iridectomy (using a scissors or a vitrectomy cutter), there is no countertraction to the posterior force when the MVR blade is used. This is especially

REFERENCE 1. Athanasiadis Y, Nithyanandarajah G, Trivedy M, Bishop D, Sharma B, Sharma A. Surgical iridotomy in aphakic eyes and eyes with anterior chamber intraocular lenses. J Cataract Refract Surg 2013; 39:1461–1462

Reply : We agree with Drs. Kumar and Chanana that relative to iris root counterpressure, a superiorly and peripherally placed iridotomy is optically and mechanically the ideal position. This should reduce the risk for iridodialysis, particularly in a thick iris. We would like to emphasize that the iris fibers have to be cut perpendicular to the dilator iris fibers and a 200 mm incision size should be sufficient. A 20-gauge MVR blade should achieve this. The cutting edges of current MVR blades are too long and tapered, requiring care in constructing the peripheral iridotomy. With the current limitations of the MVR blade design, if the main incision is superior, we think the simplest way to create a superior peripheral iridotomy is through the superior main incision created for implantation of the anterior chamber intraocular lens (IOL). The MVR blade can be passed peripherally between the haptic gaps of the implanted anterior chamber IOL through the superior main wound to create an appropriate iridotomy.dAnant Sharma, FRCOphth, James Wawrzynski, MB, BChir - Before trying the surgical technique described by Athanasiadis et al.,1 one should consider the following points. The authors did not mention what they mean by “iris fibers”; ie, “[T]he blade is kept perpendicular to the iris fibers.” The iris consists of melanocytes and fibroblasts with little collagen, iris stroma, iris sphincter, anterior and posterior epithelial layers. The perpendicular blade cuts dilator muscles, which are arranged radially, but closes when the iris dilates in mesopic conditions. Because of the abundance of fibroblasts in iris stroma, during the healing process of the iris stroma, fibrosis occludes the opening. One

J CATARACT REFRACT SURG - VOL 40, APRIL 2014