To the Editor.
—The finding by Tsuboi et al1 that the blood-aqueous barrier (BAB) was more compromised in eyes with a smaller capsulorhexis than in those with a larger capsulorhexis was, as noted by the authors, unexpected. They postulated that contact between the optics of the intraocular lens and the lens epithelium was responsible for this finding, and perhaps they are correct. However, since the unexpected in research is often the most valuable (not to mention intriguing), I wonder if there may not be another possible explanation for their results.A capsulorhexis that appears small in the postoperative period may simply represent a previously larger capsulorhexis that has contracted. This commonly observed phenomenon results from a fibrotic purse-string effect at the margins of the anterior capsulotomy. Could it be possible that this contracture of the capsular bag produces zonular traction that is transmitted to the ciliary epithelium, thereby causing
Mackool RJ. Effect of Continuous Circular Capsulorhexis and Intraocular Lens Fixation on the Blood-Aqueous Barrier. Arch Ophthalmol. 1993;111(4):430. doi:10.1001/archopht.1993.01090040020011