Sir,

We read with interest the article by Izak and co-workers, reporting clinical and pathological features of hydrophilic acrylic intraocular lenses (IOLs) of three major designs explanted because of late postoperative opacification.1

These authors analysed eight Aqua-Sense IOLs (Ophthalmic Innovations International, OII). Five of them had been explanted in South Africa, two in the UK, and one in Brazil. According to the paper, a total of 23 cases of postoperative opacification of the Aqua-Sense lenses were observed by Dr Troskie in South Africa, and the manufacturer of the Aqua-Sense lens has apparently reported 12 similar cases to the authors in a personal communication in September 2001.1

In the University Hospital Aintree, Liverpool, UK, we have exchanged 25 opacified Aqua-Sense lenses between August 2001 and July 2003. The initial Aqua-Sense IOL implantations were performed in the year 2000 and early 2001. We summarised our experience with the exchange of these lenses in a paper that we submitted recently for consideration of publication in the Journal of Cataract and Refractive Surgery.

A further nine Aqua-Sense lenses developed severe late opacification but have not been exchanged so far for various reasons, bringing the total number of opacified Aqua-Sense lenses observed in our department to 34. Thus, the overall number of opacified Aqua-Sense lenses might be higher than suggested in the article and we are wondering whether other colleagues have exchanged or observed opacified Aqua-Sense lenses.