We would like to thank Venkatesh and associates for their interest in our study. The concerns raised include the effect of vitreous disturbance during or after suturing on outcomes and recurrence rate compared to the intraocular lens (IOL) exchange surgery.

As we clarified in the Introduction section, the study compared surgical and ocular outcomes of 2 treatment options for IOL repositioning, which can be performed with minimal incisions, and the comparison between IOL repositioning of a dislocated IOL and IOL exchange was not the purpose of the study. In our clinical practice, we have performed either scleral or iris suturing procedures for the repositioning of dislocated intraocular lenses with rigid haptics, such as multipiece IOLs with optics made of acrylate or silicone and haptics made of polymethylmethacrylate (PMMA), and of single-piece IOLs made entirely of PMMA. In contrast, we have performed IOL exchange for intraocular lenses without rigid haptics, such as single-piece IOLs manufactured from acrylate or silicone, which could not be sutured to the sclera. As stated in the Methods section, 120 patients with dislocated IOLs were identified, with 42 patients who underwent IOL exchange surgery excluded. Therefore, the remaining 78 patients who underwent either scleral or iris suture fixation of dislocated IOL were included for the comparison.

Suturing on haptics outside the eye and even under direct visualization in the IOL exchange may affect the recurrence rate positively. However, potential complications owing to larger incisional wounds and longer operation time than repositioning of a dislocated IOL using scleral or iris fixation in the globe as a closed system are more important concerns, as we stated in our introduction. In addition, the recurrence rate from the study regarding IOL exchange using 3.2 mm corneal incision, by Kubaloglu and associates, cannot be compared directly to ours because the different experiment environment of each study may lead to significant bias.

Venkatesh and associates point out that the presence of either vitreous in the anterior chamber or a disturbed vitreous face can lead to multiple ocular complications. However, we already recognize this concern; therefore, we compared the frequency of perioperative complications such as endothelial cell loss, clinical cystoid macular edema, and retinal detachment between the 2 surgical procedures for IOL repositioning in our study. As we stated in the Discussion section, although these 2 surgical procedures tended to be performed in eyes with disturbed anterior vitreous faces, the frequency of perioperative complications was similar in the 2 groups. However, disturbed vitreous face may have a role in less stable refraction, with a greater hyperopic change after 1 week in the iris fixation group. Furthermore, we performed anterior vitrectomy in cases with vitreous prolapse in the anterior chamber and confirmed no vitreous strands in the anterior chamber at the end of the surgery in both groups.