Sir,

We read the article ‘Phacoemulsification cataract surgery and unplanned anterior vitrectomy—is it bad news?’ Published in March 2002 Eye with interest.

The study noted that out of 92 patients who required anterior vitrectomy, 65 did not have pre-existing eye disease; 49 out of the 57 achieved visual acuity of 6/12 or better. However, the visual outcome for the 27 who had pre-existing eye disease is not mentioned. The authors were implying that unplanned vitrectomy was not bad news; however, will this be the case if the outcome of all unplanned anterior vitrectomies were taken into consideration? Considering the 65 study patients without pre-existing eye disease, assuming the worst-case scenario, 16 (25%) had poor visual outcome, which is bad news. We would like clarification from the authors about their conclusion ‘patients who undergo complicated phacoemulsification cataract surgery do comparatively well’ when all the patients (including those with pre-existing eye disease) who underwent such procedure were not included in their study.

The study indicated that the rate of vitreous loss during phacoemulsification surgery was higher when performed by junior trainees. Correlation of the rate of vitreous loss with the presence of predisposing factors, pre-existing eye disease and the grade of the surgeon, and degree of supervision can show the true nature of the problem. With careful selection of cases for junior trainees, modular stepwise training in pehrforming phacoemulsification surgery, adequate supervision and mandatory completion of the basic microsurgical course can decrease the problem of vitreous loss during surgery.