Comments on: A study on the association of A-scan parameters and intraoperative complications during cataract surgery in eyes with pseudoexfoliation syndrome

To the Editor, I read with interest the study by Sruthi and Saikumar, in which they assessed the association of preoperative A-scan parameters with intraoperative complications of phacoemulsification in eyes with pseudoexfoliation syndrome. They concluded that patients with shallow anterior chambers or thick lenses were at a higher risk for complications during cataract surgery.[1] However, while the authors provide a P value regarding the comparison of A-scan parameters between patients who experienced intraoperative complications and those who did not, the absence of detailed statistical methodologies raises some concerns. Robust regression analysis would have been instrumental in identifying the specific parameters associated with complications, especially given the potential confounders present in the study, such as variations in cataract grade, zonular status, pupillary dilation, and the differing experience levels of surgeons involved.[2,3] A thorough explanation of these analytical choices would greatly enrich the study’s implications. Furthermore, the study references the risk of glaucoma in cases of pseudoexfoliation, particularly mentioning angle closure in the introduction. Nonetheless, there is no discussion regarding the preoperative intraocular pressure (IOP) or the glaucoma status of study subjects, which is a critical parameter that warrants consideration when analyzing intraoperative complications. When dealing with eyes that have a shallow anterior chamber, several surgical challenges may arise, including the risk of capsulorhexis extension and potential trauma to the corneal endothelium.[4] It would greatly benefit readers to learn about the precautions and preoperative strategies employed by surgeons to mitigate these challenges. Information on the use of preoperative hyperosmotic agents, partial pars plana vitrectomy, adjustments in phaco-machine parameters, specific chopping techniques, and the selection of cohesive or dispersive viscoelastic could be invaluable. A response from the authors addressing these concerns would enhance the translational value of their study and assist ophthalmic surgeons in achieving optimal outcomes for patients with pseudoexfoliation syndrome undergoing cataract surgery. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.