We thank Parekh and associates for their thoughtful comments and interesting description of a case of blood reflux during cataract surgery 2 years after previous Trabectome surgery. The authors raised several plausible mechanisms for intraoperative blood reflux in patients who undergo intraocular surgery after Trabectome surgery. However, these mechanisms may not apply to cases of repetitive spontaneous hyphemas that occur in the absence of subsequent surgery, as represented by our series.

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