Author's Reply.

Sir,

We thank Agarwal et al for their interest on our article “Primary and secondary implantation of scleral fixated intraocular lens in adult patients”.1

We agree with Agarwal et al's that complications such as cystoid macular edema and glaucoma can occur secondary to both penetrating keratoplasty and scleral fixated intraocular lens (SFIOL). In our series glaucoma and cystoid macular edema were observed in two separate patients who underwent combined penetrating keratoplasty and SFIOL. Excluding these two patients form the statistical analysis did not change the results - the values were not statistically significant.

We also agree with Agarwal et al's comment that trauma related corneal and retinal damage can lead to bias when comparing patients with primary and secondary SFIOL implantation as all trauma cases were included in Secondary Group (scleral fixated intraocular lens was implanted at a different session). However, the cases of trauma had postoperative corrected distance visual acuities of 0.2 (one patient), 0.7 (three patients) and 0.8 (one patient, in decimal notation) and no patient had posterior segment injury. As these patients had no trauma-related causes of visual reduction, they were not excluded from the secondary group for statistical analysis of visual acuity.