Sir,

Although posterior capsule opacification has been much reduced by changes in intraocular lens design, it still remains a problem and, therefore, the report ‘Irrigation of the capsular bag using a sealed-capsule irrigation device and 5-fluorouracil’ by Milverton is of great interest, as irrigation of the capsular bag using the Milvella-sealed capsule irrigation device has the potential to destroy all lens epithelial cells without bystander damage in the rest of the eye. Previous attempts to hydrolyse lens epithelial cells in the bag using this device by irrigating with distilled water have failed, as residual cortical material appears to protect the equatorial cells. The author claims that irrigation with 5-fluorouracil prevented posterior capsule opacification in this case up to 1 year after surgery.

However, a careful perusal of the 12-month image shows that there is clearly fusion of the capsular bag around the intraocular lens haptics, which would suggest that viable lens epithelial cells are still present and that PCO may be delayed rather than prevented by irrigation with 5-fluorouracil.