LAUSR

To the Editor: We read with great interest the recently published article “comparison of fellow eye of acute primary angle closure and phacomorphic angle closure”1 by Moghimi and colleagues and would like to appreciate the work of the authors for the same. We would like to highlight a few points in the study which require some clarification. Initially, it was mentioned that anterior segment optical coherence tomography (ASOCT) images were obtained before any therapeutic procedure but later the authors have mentioned that ASOCT images were taken after the attack was broken following administration of intravenous mannitol, oral acetazolamide, topical timolol. Second, the authors have mentioned that they excluded the eyes in which attack could not be broken but we would like to know whether only one single dose of mannitol and acetazolamide was given or multiple doses were given to break the attack and after how many hours of mannitol instillation was the ASOCT of the fellow eyes done as this would affect the parameters being studied. This point is supported by Smith and Drance2 who found that mean reduction of intraocular pressure was 48% in normotensive eyes with return to its initial value between 21⁄2 to 41⁄2 hours after instillation of mannitol. Third, the authors have mentioned in the description that Table 3 shows different biometric parameters to differentiate fellow eyes of acute primary angle closure (APAC) eyes and fellow eyes of phacomorphic angleclosure eyes whereas the title of Table 3 mentions biometric parameters to differentiate phacomorphic angle closure (AC) eyes and APAC eyes.1 In the discussion, the authors have mentioned that determinants of narrow-angle width were smaller ACA and thicker and steeper iris for fellow eyes of APAC and smaller ACA and greater lens vault (LV) for fellow eyes of phacomorphic AC. It would have been more informative if anterior vault and relative vault were included in the ASOCT measurements rather than just absolute value of LV.3 Finally, the authors have concluded that laser peripheral iridotomy is not recommended in fellow eyes of phacomorphic AC as fellow eyes of phacomorphic AC have flatter iris demonstrating less pupillary block but we would like to mention that there is high LV (781.1± 294.4 μm) in fellow eyes of phacomorphic as compared with fellow eyes (391.7 ± 377.5) of mature cataract. High LV can also cause pupillary block,4 so even if the iris is thin the LV which in itself is a high risk factor can induce pupillary block. Hence laser peripheral iridotomy should be done to prevent pupillary block in such cases. This point is further supported by study which reports that iris configuration is largely determined by the position of the lens in most cases.5