authors reply 2

July - August 2009 327 Letters to the Editor Secondly, the rationale of silicon oil injection is not very clear in this case The occurrence of macular pucker after surgery for retinal detachments complicated by severe proliferative vitreo-retinopathy has not shown to be inßuenced by the choice of intraocular tamponade in the Silicon Oil Study.[2] In fact, a second surgery could have been avoided by using a longacting gas instead Also, C3F8 gas has been found to be a more effective tamponade than silicone oil with respect to achieving initial closure of macular holes in a study by Lai et al.[3] Vinod Kumar, Basudeb Ghosh, Meenakshi Thakar, Neha Goel Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India We appreciate author’s concerns regarding the management of the case Nazimul Hussain, Subhadra Jalali, Alka Rani, Hema Rawal Smt Kanuri Santhamma Retina Vitreous Centre, LV Prasad Eye Institute, Hyderabad, India Correspondence to Dr Nazimul Hussain, Smt Kanuri Santhamma Retina Vitreous Centre, L.V Prasad Eye Institute, L.V Prasad Marg, Banjara Hills, Hyderabad - 500 034, Andhra Pradesh, India E-mail: nazimul@lvpei.org References Kumar V, Ghosh B, Thakar M, Goel N Retinal pigment epithelium atrophy following indocyanine green dye–assisted surgery for serous macular detachment Indian J Ophthalmol 2009;57:326-27 Hussain N, Jalali S, Rani A, Rawal H Retinal pigment epithelial atrophy following indocyanine green dye-assisted surgery for serous macular detachment Indian J Ophthalmol 2008;56:423-5 Cox MS, Azen SP, Barr CC, Linton KL, Diddie KR, Lai MY, et al Macular pucker after successful surgery for proliferative vitreoretinopathy Silicone Study Report Ophthalmology 1995;102:1884-91 Correspondence to Dr Vinod Kumar, 9/2 Punjabi Bagh Ext, New Delhi - 110 026, India E-mail: drvinod_agg@yahoo.com References Hussain N, Jalali S, Rani A, Rawal H Retinal pigment epithelial atrophy following indocyanine green dye-assisted surgery for serous macular detachment Indian J Ophthalmol 2008;56:326-27 Cox MS, Azen SP, Barr CC, Linton KL, Diddie KR, Lai MY, et al Macular pucker after successful surgery for proliferative vitreoretinopathy Silicone Study Report Ophthalmology 1995;102:1884-91 Lai JC, Stinnett SS, McCuen BW Comparison of silicone oil versus gas tamponade in the treatment of idiopathic full-thickness macular hole Ophthalmology 2003;110:1170-4 DOI: 10.4103/0301-4738.53069 Authors' reply Sir, We want to thank the reader[1] for taking keen interest in this case report which depicts the most adverse effect of ICG on retinal pigment epithelium (RPE) cells.[2] We have clearly mentioned in the article that while ßuid-air exchange was performed using silicone brush cannula, the macula ßattened This may also suggest that microhole was present in the foveal area which was also evident when ICG migrated subretinally Hence, a retinotomy was not created We used silicone brush or silicone-tipped ßute needle for all macular surgery We appreciate author’s conclusion The choice of intraocular tamponade was not based on the occurrence of macular pucker as mentioned by authors.[3] In fact, the choice would have been intraocular gas either SF6 or C3F8 However, our decision was based on the following: Extensive area of RPE ICG staining which may affect the reattachment of the macula as a large area of serous detachment was seen preoperatively on OCT and clinically.[3] Patient did not want gas tamponade as discussed preoperatively She had surgery earlier for vitreomacular traction with serous macular detachment with intraocular gas DOI: 10.4103/0301-4738.53070 Optical coherence tomography in a patient with chloroquine-induced maculopathy Dear Editor, We read with interest the article ‘Optical coherence tomography (OCT) in a patient with chloroquine- induced maculopathy’ by Korah et al.[1] We must congratulate the authors for the excellent article but we would like to make a few points Why was the patient started on chloroquine rather that hydroxychloroquine? It is well-documented that hydroxychloroquine has a lower incidence of eye complications compared to chloroquine.[2] Was the patient regular about her follow-up schedules? What were the Þndings in the examination done just before the complications were noted? Did the patient have any corneal deposits? Corneal deposits though innocuous are the most commonly described ophthalmological Þndings following chloroquine therapy.[2] Was a visual field examination done at that time? Were there any retinal pigment epithelium (RPE) alterations? What was the protocol for taking fundus pictures and /or visual Þeld examinations? Examination and perimetry reliably showed chloroquine toxicity and yet the patient was not told to stop chloroquine but the drug was changed to hydroxychloroquine