Thank you for drawing our attention to earlier case reports of inferior corneal edema related to both lens fragments and inert foreign body particles. As mentioned in our manuscript, theories for corneal edema related to unencapsulated lens material include both mechanical trauma and immune-mediated processes. We agree that the example of edema related to inert particles in the anterior chamber, presented by Laibson and associates, supports mechanical endothelial cell injury as an explanation for inferior edema. Moreover, it does seem plausible that movement of the iris may translate to repeated rubbing of a lens fragment against the local endothelium. However, the etiology of corneal edema related to retained lens fragments is likely more complex than simple mechanical trauma—as multiple examples of edema related to lens fragments in the posterior chamber exist. We could not agree more that specular microscopy results would have been a powerful addition to our data, and we strongly recommend obtaining such information when similar research is conducted in the future.
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