We are glad that Dr. Rao and colleagues have shown interest in our paper1 and raise some interesting questions about possible differences in intraocular pressure (IOP) between eyes with threat to fixation (TTF) and eyes without TTF. We did not include IOP in the original analysis. One reason was that we firmly believe that TTF has rarely been considered an important factor when determining target IOP, as opposed to the magnitude of field loss, rate of progression, and IOP. We also knew that it would be impossible to reliably determine reasons for treatment decisions because of the retrospective nature of the study.

An 8-year-old boy was observed for 5 years for an enlarging, pigmented lesion on his left lower lid (Fig 1). An excisional biopsy was performed and histopathology (H&E) revealed skin with keratinized, stratified squamous epithelium in a papillomatous configuration (Figs 2 and 3). The lesion had nests of densely pigmented melanocytes within the epithelium (black arrows), at the epithelial-stromal junction (white arrows) and within the underlying stroma (asterisks). The history of growth and the junctional location are of much less concern in a juvenile nevus than in an adult nevus.

The article by Koolwijk et al1 is welcomed, but we believe the title should be reworded. The authors looked at nearly 7000 consecutive cataract operations using topical/intracameral anesthesia without sedation, and concluded that “Cataract surgery can be safely performed in an outpatient clinic, in the absence of the anesthesia service and with limited workup and monitoring. Basic first aid and basic life support skills seem to be sufficient in case of an adverse event. A medical emergency team provides a generous fail-safe for this low-risk procedure.” We generally agree with this conclusion, but disagree with the title, which states that “Incident and Procedural Risk Analysis Do Not Support Current Clinical Ophthalmology Guidelines.”

We thank Eke et al for their critical appraisal of our article. Also we are delighted to learn that they, as co-chairs of the committee that produced the 2012 guideline “Local Anesthesia (LA) for Ophthalmic Surgery” find our work a welcome addition to the body of evidence for future clinical guidelines.1

Liu y otros (p. 2243), utilizaron la tomografía de coherencia óptica de dominio espectral (SD OCT) para examinar si el adelgazamiento progresivo de la capa de fibras nerviosas de la retina (RNFL) se presenta en el ojo contralateral de pacientes con glaucoma con progresión unilateral diagnosticada originalmente mediante campos visuales o fotografía del disco óptico. Observaron pérdida de la RNFL en los ojos contralaterales de un número sustancial de pacientes. Este estudio de cohorte prospectivo longitudinal incluyó 346 ojos de 173 pacientes (118 ojos con glaucoma y 228 ojos con sospecha de glaucoma a la determinación de la línea de base).