In Reply Dr Burris stated that the slitlamp photograph as well as the ultrasound biomicroscopic image presented by us1 appear identical to the pigmented elevation seen in Axenfeld nerve loops. Indeed, smaller pigmented episcleral lesions located within a 3- to 4-mm distance from the limbus, sometimes with an associated ciliary artery branch, might represent Axenfeld loops constituting an intrascleral loop of a long posterior ciliary nerve.2 Also in our case, an Axenfeld loop could have been a guiding structure, along which melanocytic nevus cells have passed through the sclera. Nevertheless, manipulation of the episcleral nodule prior to surgery as well as the excisional procedure itself were not at all perceived as painful by this patient, thus making the presence of an underlying sensory nerve loop less likely.3
Koch KR, Heindl LM. Axenfeld Loop vs Extrasclerally Extending Ciliary Body Tumor—Reply. JAMA Ophthalmol. 2016;134(7):846. doi:10.1001/jamaophthalmol.2016.1033
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