LETTERS

Yeoh, Ronald FRCS, FRCOphth

Author Information

From the Camden Medical Centre, Singapore.

Corresponding author: Ronald Yeoh, FRCS, FRCOphth, 13-03 Camden Medical Centre, One Orchard Boulevard, Singapore 248649. Email: [email protected].

Disclosures: R. Yeoh is a consultant to Alcon, Johnson & Johnson and Zeiss.

Journal of Cataract & Refractive Surgery | DOI: 10.1097/j.jcrs.0000000000001453 Metrics

I read with interest the article by Arad et al. regarding the association between anterior chamber biometry and posterior capsular defects.1 We usually use the numbers generated by our biometry devices for our calculations to choose an appropriate intraocular lens power. However, some of these numerical values help us in surgical planning and in particular risk assessment as shown in this paper.

The higher lens thickness (LT) values in the posterior capsule defect (PCD) cohort serve as a warning that the surgery is at greater risk of posterior capsular rupture largely because the thicker the lens, the more mature and harder the nucleus is likely to be. The zonular fibers could also be weaker. So it is not the high LT value per se that is dangerous, it is the association with a more mature cataract. It may, however, be simplistic to say that high LTs alone are associated with higher risk of PCD. Thinner than average (say approximately 3.5 mm) nuclei with lower LT numbers may also lead to higher risk of posterior capsule rupture if the surgeon is unaware and is sculpting deep or uses a prechopper plunged into the heart of the nucleus. It would be interesting to know the PCD rate for those whose LTs were less than 4 mm.

A shallow anterior chamber depth (ACD) (say under 3 m) is also suggested as an added risk factor of PCD, although less so than with increased LT. The presence of a reduced ACD is perhaps more a risk factor to the corneal endothelium, be it from ultrasound or instrumentation in the shallow anterior chamber.

Arad et al. do us a great service by bringing attention to the importance of looking at other frequently ignored numbers like LT and ACD in our biometric data.

1. Arad T, Engel X, Ackermann H, Schmack I, Kohnen T. Association between anterior chamber biometry and posterior capsular defects. J Cataract Refract Surg 2023;49:1086–1091 Copyright © 2024 Published by Wolters Kluwer on behalf of ASCRS and ESCRS