We would like to thank Dr Çekiç for his interest in our article and appreciate his insightful comments.
As Dr Çekiç has pointed out, some studies have suggested the presence of the lens may protect the anterior segment from oxidative stress and may delay the development of open-angle glaucoma. Additionally, Beebe and associates have suggested that preservation of the vitreous body and the lens would protect against nuclear sclerotic cataract and open-angle glaucoma because the vitreous body and the lens are 2 important oxygen consumers. Sawa and associates performed nonvitrectomizing vitreous surgery for epiretinal membrane in order to prevent progression of nuclear sclerosis after vitrectomy. When the vitreous body was not removed, the lens did not develop cataract for up to 5 years. It would be very helpful for the understanding of the pathogenesis of ocular hypertension after vitrectomy to compare the incidence of late-onset ocular hypertension between vitrectomized eyes and eyes that underwent nonvitrectomizing vitreous surgery. However, the indication for nonvitrectomizing vitreous surgery is limited and the development of nuclear sclerotic cataract after vitrectomy is very common. In reality, surgeons have to perform conventional full vitrectomy combined with cataract surgery in many cases, especially in elderly patients. The exact mechanism that contributes to the late-onset ocular hypertension after vitrectomy has not been determined, but evidence suggests that increased oxidative stress or oxidative damage of the cells making up the trabecular meshwork contributes to the elevated IOP. Oxygen levels in the eye are firmly regulated and the removal of the vitreous body alters the biochemical environment. As Beebe and associates have suggested, surgeons should try to preserve the intraocular environment to maintain normal oxygen gradients in the eye if possible. Realistically, long-term intraocular pressure monitoring after vitrectomy in pseudophakic eyes is feasible.