The authors stand by their comments.

In our study,1 the original frequencies of epiretinal membranes reported were crude (33% in eyes with cataract surgery vs 19% in eyes without cataract surgery). When the frequencies of epiretinal membranes were adjusted for age, there was little change (33% vs 21%) and the age-adjusted P value remained at <0.001. Because these data are cross-sectional, we cannot infer the temporal relationship of the association from these data, that is, which is antecedent and which is consequent.

The article by Jiang et al1 in the April 2015 issue of Ophthalmology is beautifully done. The authors are to be congratulated for commenting that the rim width “decreased” rather than the rim getting “thinner.” Thickness and width are not synonymous. The optic nerve head has both width and thickness, or narrowness and thinness. The “cup” of the optic nerve can become deeper (i.e., a change in thickness) or wider (i.e., a change in the lateral direction, not the anterior–posterior direction). The finding that width of the neural retinal rim becomes narrower in response to short-term elevations of intraocular pressure is a powerful commentary on the plasticity of the optic nerve head.

We thank Professor Spaeth for his interest in our study and we fully agree with his comments on the plasticity of the optic nerve head as shown by the width of the neuroretinal rim of the optic nerve head getting narrower in response to a short-term increase in intraocular pressure.1,2 We also fully agree on the terminology he recommends, using the term narrowing for a decrease in the neuroretinal rim width in radial direction, and of using the term thinning for a decrease in the thickness of the rim as measured in sagittal direction.

A 46-year-old woman presented with pain and an intraocular pressure of 63 mmHg in the left eye 2 years after plaque brachytherapy for uveal melanoma. Examination revealed pigmented material in the anterior chamber (Fig 1), a choroidal mass (Fig 2), and marked pigmentation in an open trabecular meshwork with gonioscopy. Histopathology of this blind, painful eye confirmed the diagnosis of spindle B type uveal melanoma (Fig 3), with foci of necrosis and pigment laden macrophages (melanophages). Melanophages (black arrow) were deposited on the ciliary body (CB), iris (I) and in the trabecular meshwork (white arrow, Fig 4; C indicates cornea).

Corneal hydrops is an uncommon condition occurring in 2%−3% of patients with keratoconus. It is caused by a leak of aqueous into the cornea through a tear in Descemet's membrane causing severe corneal edema (Fig 1). Acute hydrops occurred in a 51-year-old man. The hydrops resolved over 4-months with conservative medical treatment, and a penetrating keratoplasty was performed. The histopathology (hematoxylin and eosin and periodic acid-Schiff) revealed thinning of the apical stroma (Fig 2, asterisk), breaks in Bowman's membrane (Fig 3, white arrow) and subepithelial bullae (Fig 4, open arrow).