We read with great interest the article by Chan and associates evaluating the visual outcomes and complications between patients implanted with primary anterior chamber intraocular lens (ACIOL) or secondary scleral-fixated intraocular lens (IOL) with over 5 years mean follow-up. It is a common dilemma that the surgeon faces and questions arise about what would be best for the patient, as no clear-cut guidelines exist.

We noted a typographical error in Table 1 and numerical values seem to have been interchanged about the planned surgeries.

Preoperative best-corrected visual acuity (BCVA) in the secondary scleral-fixated IOL group could have been recorded and correction should have been made to know if there was any drop in the visual acuity due to the primary complicated cataract surgery per se. The reasons for preferring primary ACIOL or secondary scleral-fixated IOL besides age could have been elucidated further. Subgroup analysis, for example of pseudoexfoliation patients, the type of IOL used and their outcomes would have been helpful.

The authors have attributed the loss of BCVA from 1 year postoperatively to BCVA at last follow-up only to late complications. Specific reasons for this loss of BCVA and considerations for other factors like age-related macular degeneration should have been made.

Endothelial cell loss is considered to be greater in ACIOL than in scleral-fixated IOL. But corneal decompensation over the long term was comparable in both the groups in the present study. Earlier studies have reported comparable endothelial cell loss in ACIOL and scleral-fixated IOL in cataract surgery and penetrating keratoplasty. Prospective studies could be undertaken to evaluate for the same.