Sir,

We thank Prof. Jagat Ram for his interest in our study of the outcomes of pediatric cataract surgery in Durban, South Africa.1 We agree that a 3-month follow-up is not the best time to report the outcomes of developmental and congenital cataract surgeries as the visual outcome would improve over time. This has been mentioned as a limitation in the Discussion section. However, this is the first such report from the southern part of the African continent.

There was only one child with Rubinstein Taybi Syndrome whose intra-ocular pressure was >20 mm of Hg (it was 24 and 38 mm of Hg in each eye). She had congenital glaucoma and needed bilateral Ahmed valve surgery. With such a small sample we cannot say that there was a difference between aphakic and pseudophakic children’s eyes for glaucoma. There were 7 micophthalmic eyes in our series. A peripheral iridectomy was done in those eyes. An Alcon Acrysof IQ hydrophobic acrylic single piece intra-ocular lens was placed in the bag for all the pseudophakic eyes, all congenital and developmental cataracts in children >4 months of age. The aphakic eyes were prescribed spectacles at the first week follow-up. Amblyopia treatment in form of patching the good eye and spectacle dispensing was done at the 1-week follow-up as mentioned in the Materials and methods section.

The Inkosi Albert Luthuli Central Hospital, Durban is a quaternary care centre for the Kwa-Zulu Natal province of the Republic of South Africa. It is staffed with optometrists trained in pediatric optometry who are well versed in refraction, spectacle dispensing and amblyopia treatment of children. It aspires to follow the Royal College of Ophthalmologists norms. As the children were very young, with poor vision, their pre-operative strabismus could not be accurately measured. Many had nystagmoid movements. Our data collection may not have been very accurate about these two parameters, hence they were not included in the Results and Discussion.

But the series shows that it is possible to have a relatively good outcome even in very young children who undergo pediatric cataract surgery in Africa. The challenge is getting the children, as early as possible, to the pediatric ophthalmology centre to undergo the ‘surgery for sight’. And then to follow those up diligently and regularly ensure proper amblyopia treatment to ensure a good visual outcome.2, 3, 4