Primary posterior capsulectomy with anterior vitrectomy in adult traumatic cataracts.

Sir,

We read with interest the article “Maximizing the visual outcome in traumatic cataract cases: The value of a primary posterior capsulotomy and anterior vitrectomy” by Shah et al.[1] It is a very well written article with 1-year follow-up of management of cases of traumatic cataracts undergoing cataract surgery with posterior capsulectomy and anterior vitrectomy. Authors have shown that primary posterior capsulectomy with anterior vitrectomy improves visual outcomes during 1-year follow-up in all age groups.

Authors have reported that the incidence of retinal detachment (RD) was lower in the treatment group than compared to controls. We would like to suggest that adult patients undergoing primary capsulectomy should have an even longer follow-up period. Also would like to suggest that the surgical procedure be compared with Nd:YAG capsulotomy in adult patients.

We would like to highlight a case–control study by Erie et al.,[2] which found a posterior capsular tear at surgery significantly increased the risk of RD in a 25-year period. Other nicely designed studies also have demonstrated similar findings.[34] Erie et al. found lesser number of cases of RD following Nd:YAG capsulotomy than posterior capsular tears. Though there are studies, which show a high incidence of RDs following Nd:YAG capsulotomies,[4] but have not compared with posterior capsular tears.

Though Yazici et al.[5] have shown that cataract surgery combined with primary posterior curvilinear capsulorhexis as a safe procedure with a low rate of complications. But they did not disturb the anterior hyaloid phase and did in the bag implantation in all cases.