Sir,

We thank Dr Thyagarajan for his interest and comments on our paper.1 We recruited 10 consecutive patients into the study which means that no patient was excluded during the period of study. Argon laser peripheral iridoplasty (ALPI) is an easily mastered procedure and requires the availability of an argon laser machine, which we think is widely used in most of the eye institutions. The issue may be pertinent in developing countries but our hospital is equipped with the argon laser machine mainly for the treatment of diabetic retinopathy and therefore, no extra cost is required for its use in the treatment of acute phacomorphic angle-closure.

One of our 10 patients had a 50% rise in the intraocular pressure (IOP) 15 min after ALPI. The IOP decreased gradually to below 25 mmHg in 4 h although systemic acetazolamide was given. If we consider the fact that the other nine patients had steady decrease in the IOP after ALPI, the failure of one case would not have implied an unpredictable IOP lowering effect of ALPI. Concerning the persistent angle closure in eight of our patients, we have admitted in the discussion that our study was unable to find out the exact IOP lowering mechanism of ALPI. Nevertheless, we concluded from the preliminary study that ALPI appeared to be safe and effective as the first-line treatment of acute phacomorphic angle-closure. We agree that in vitro study and randomized controlled clinical trial are needed to shed more light on it.