Thank you very much, Dr. Khawaja Khalid Shoaib, for your interest in our article, Posterior Iris-claw Aphakic Intraocular Lens Implantation in Children.
We agree with Dr. Shoaib regarding the rather short 31-month average follow-up in our study. The evaluation of spontaneous posterior iris-claw intraocular lens (IOL) disenclavation does require long-term follow-up and we therefore mentioned this point as a limitation of our study in the conclusion of our article.
The reason we do not re-enclavate a haptic of a traumatically disenclavated posterior iris-claw IOL in children is a matter of safety. As pointed out by Dr. Shoaib, one of the most serious complications of this alternative fixation technique is the posterior IOL dislocation into the vitreous cavity. The traumatically disenclavated haptics of an iris-claw IOL have to be considered to be potentially damaged. This was indeed the case in our study eye. Therefore, an IOL exchange after a traumatic posterior iris-claw IOL disenclavation seems to be a feasible approach to minimizing further complications.