We read with great interest the study by Leydolt and associates investigating the long-term posterior capsular opacification (PCO) severity associated with the use of 2 acrylic hydrophobic intraocular lenses (IOL). They concluded that the differences between groups were statistically significant, which were particularly attributed to material properties and manufacturing processes.

Although all the surgeries were being performed by a single highly experienced surgeon (R.M.) who employed a standardized surgical procedure and postoperative therapeutic regimen, we would like to stimulate the authors to provide additional information. It is not clear whether minimal intraoperative iris bleedings or traumas, the use of intraoperative iris hooks, and the presence of a marked anterior chamber postoperative inflammatory reaction were part of the exclusion criteria. Also, the authors reported that “there were no surgical complications that would have led to patient exclusion,” failing to detail which ones they would have regarded as exclusion criteria for this particular study.

It is interesting that the authors reported that in 21 eyes (14% of the sample), the anterior capsulorhexis-IOL optic overlap was not complete, adding that there was no statistically significant difference between the 2 groups. However, given the reported correlation of the ciliary sulcus diameter with the anterior chamber depth, it is also true that capsular bag diameters may vary in accordance with anterior chamber depth or axial length, and the authors could specify whether these characteristics were similarly distributed in the 2 studied groups. A further possibility is that one of the studied IOLs might be more “sensitive” to incorrect rhexis sizing, perhaps because of a slightly different lens geometry. Perhaps it might be useful to exclude all the patients with inappropriate rhexis sizing in order to verify whether the study’s conclusions would still hold true.

Finally, the rate of patients lost to follow-up was in excess of 20%, and this should have been highlighted among the limitations of the study, given that the study was designed as a randomized prospective study.