Diathermy for Posterior Capsule Opacification

We congratulate Bretton and coauthors1 on their study of the use of bipolar diathermy to prevent posterior capsule opacification (PCO). The diathermy instrument used has a sharp tip to focus the flow of current to a single point. We regularly use radiofrequency diathermy to cut the anterior and posterior capsules in pediatric cataracts. The study does raise some questions that we would like the authors to clarify. 1. In the study, diathermy application was performed following a manual continuous curvilinear capsulorhexis (CCC) and no damage to the capsulorhexis was noticed. In our experience (unpublished work), the CCC created by cutting diathermy tends to be larger than the intended size and also weaker than manual CCC, as reported by others.2 Will diathermy application not have an effect on the integrity of a capsulorhexis made using cutting diathermy? 2. Can cutting diathermy be used to deliver minimal energy to dislodge the viable lens epithelial cells (LECs) without compromising the capsule strength? In our opinion, it would be ideal to have a single diathermy that could be used for cutting the capsule as well as dislodging viable LECs or a mechanism to switch from a cutting mode to a polishing mode. 3. Is it possible to develop an intracapsular diathermy that could have a direct effect on the equatorial cells, as the extracapsular method mentioned in the study could cause damage to ciliary processes? Narendra Dhingra FRCSEd Arvind Chandna FRCOphth Liverpool, United Kingdom