Authors response to comment on “A study on the association of A-scan parameters and intraoperative complications during cataract surgery in eyes with pseudoexfoliation syndrome”

Dear Editor, We sincerely appreciate your interest in our article and are grateful for your thoughtful comments and queries. We aimed to minimize confounding factors in this study by excluding patients with obvious lens subluxation and by including only eyes operated on by five cataract surgeons with comparable levels of surgical experience. Pupillary dilatation was assessed and found to have no significant correlation with the incidence of intraoperative complications, likely due to our consistent use of pupil-expanding devices for smaller pupils—a strategy supported by current cataract surgery protocols in pseudoexfoliation syndrome.[1] Regarding preoperative intraocular pressure (IOP), only patients with normal IOP—whether controlled with or without medication—were included for cataract surgery. Though glaucoma is a known risk factor for intraoperative challenges in pseudoexfoliation eyes, our study focused primarily on anatomical A-scan parameters.[2] We agree that detailed glaucoma staging and its surgical implications should be explored in future research. Our sample size, while substantial for a single-center retrospective study, was not sufficient to perform multivariate analysis on each potential confounding factor, such as cataract grade or glaucoma severity. However, we recognize the importance of these variables and intend to incorporate them in the design of a larger prospective trial as suggested in other observational studies.[3] Hyperosmotic agents were not used routinely but were administered selectively in eyes with extremely shallow anterior chambers, depending on surgeon preference and preoperative assessment. As with all challenging anterior segment cases, our surgeons adhered to safety measures widely endorsed in literature—such as the use of dispersive ophthalmic viscosurgical devices (OVDs), slow-motion phacoemulsification with reduced parameters, and meticulous nuclear disassembly into smaller fragments.[4,5] Once again, we thank the authors for their constructive critique which will certainly help guide future refinements in research and clinical practice. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.