Post-Traumatic Cilia Remaining Inert in the Posterior Chamber for 50 Years

Round 1

Reviewer 1 Report (Previous Reviewer 3)

1         please add the OCT data

2      please resubmit once you have the slide


  3   please add this to the results

4       what ciliary body reaction would cause an increase in IOP? Is
there a paper or reference to support this?

5         So IOP spike could be caused by overfill- I am not sure
inflammation is the cause of it- please amend the paper

 6 So please change your conclusion that you support taking cilia out to
improve symptoms and focus that careful f/u on IOP and inflammation
should be done, as after any case

Author Response

Thank you for your appreciations and recommendations.

The text has been improved in several sections, according to the recommendations.

Below are our responses to your comments.

1. Please add the OCT data

Response: The text was corrected as recommended.

2. Please resubmit once you have the slide

Response: Unfortunately we had some difficulties in obtaining the image from the histopathological examination because the patient lives in another city and the examination was performed at a private service. We have contacted colleagues of the histopathology department and we expect to receive the image in a few days. When we get the image, it will be uploaded to manucripts.

3. Please add this to the results

Response: Once we receive the image it will be added to the final version of the manuscript.

4. What ciliary body reaction would cause an increase in IOP? Is there a paper or reference to support this?

Response: The incidence of intraocular cilia after trauma is very low, and has been described in few cases. Intraocular cilia have usually been reported in the anterior chamber, or even more rarely, in the posterior segment. However, there were no reports of cilia being embedded in the ciliary body, so we did not have a correspondent. The cause of increase IOP at our patient remains controversial, there is no certainty that increased pressure was associated strictly to the viscoelastic substances used and / or also due to an exaggerated local inflammatory response caused by the eyelash extraction.

5. So IOP spike could be caused by overfill- I am not sure inflammation is the cause of it- please amend the paper

Response: The text was corrected as recommended.

6. So please change your conclusion that you support taking cilia out to improve symptoms and focus that careful f/u on IOP and inflammation should be done, as after any case

   Response: The text was corrected as recommended.

Reviewer 2 Report (Previous Reviewer 2)

From the manuscript I couldn’t make conclusion that there are some relationship between the disease and COVID-19 infection, so last time I have asked whether it is relative to COVID-19 infection? Then the authors changed the title into “Post-traumatic cilia remaining inert in the posterior chamber for 50 years”, I think it’s reasonable. Although the authors still couldn’t explain why there is strong ocular reaction in the first postoperative day, compared with before modification, the logic is more smooth. Preoperative routine examinations and imaging analysis are listed, and pictures of intraocular cilia removed after operation are added, which more strongly prove that the surgical results are not affected by inflammation and are more rigorous. 

Author Response

Thank you for your appreciations. In this case, the association with COVID-19 infection was strictly related to repeated episodes of coughing, which led to the patient's symptoms (the appearance of the "shadow"). New data have been added to the previous version to complete the case.

Round 2

Reviewer 1 Report (Previous Reviewer 3)

OK

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

1. Authors should follow the author guideline.

2. Authors should add the references with the updating references not more than 10 years old.

3. Introductions should declare the urgency of study

 

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

The authors presented an interesting case. This case focuses on a 58-year-old female patient who had a history of trauma and corneal perforation 55 years ago, and developed intraocular eyelashes during COVID-19 infection. There may be some link between the two diseases. Authors explore the possible causes of the attacks in the patient; the cilia in the eye had not moved for 55 years, while during the COVID-19, she had recurrent cough, which may have caused the movement of the cilia in the eye, leading to the patient's symptoms. The strong reaction of the eye in the first postoperative day shows that the management of such cases remains controversial, primarily due to its severe inflammatory risk. The case is special and the manuscript is well written, however, the following concerns have to addressed before the consideration of the manuscript to be published in the journal of Diagnostics.

 

Why there is strong ocular reaction in the first postoperative day? Whether it is relative to COVID-19 infection? Maybe it can be added that the abnormal results of blood routine and coagulation function examination to see whether there are other inflammatory indicators in the whole body, which makes the conclusion more convincing. Give a brief description of the patient's general examination.

Author Response

Please see the attachment

Author Response File: Author Response.docx

Reviewer 3 Report

1."All data 37 suggested that the wondering shadow was caused by an intraocular eyelash" -  Can you provide VF, UBM or OCT data?

In the OCT imaging, is the lash inserted in the capsule?

2." 55 years is a lot of time - please use an English professional editor to make the text more scientific

3. why didn't you wash the ac with Cefruxim?

4. can you provide the histo-slide of the cilia?

 

5." day she accused no more pain " please work with an English expert

 

6. can you provide data on f/w for one month? Was the shadow reduced?

7. why would there be uveitis by removing the eyelash?

8. did she get topical NSAIDs or steroids post-tx?

9.. Why do you consider she had inflammation the next day? You don't report on cells or haze; it could be OVD left in the eye

 

10 .if the patient is happy ten weeks post Sx, why would it be regarded countervail- long f/u report is needed here to see if the intervention was successful

 

 

 

Author Response

Please see the attachment

Author Response File: Author Response.docx