To the Editor.
—Tsuboi et al1 recently demonstrated that eyes that had undergone capsulorhexis with in-the-bag fixation of an intraocular lens had a higher permeability index to fluorescein than eyes that had undergone out-of-the-bag fixation. They concluded from these data that in-the-bag fixation with capsulorhexis produces greater damage to the blood-aqueous barrier than does out-of-the-bag fixation. I believe that the measurements reported by the authors are correct and accurate, but I would like to offer another explanation for their findings.When fluorescein is given intravenously, it enters the anterior chamber primarily via the anterior uvea and the corneoscleral limbus. The former pathway is most important during the early phase of entry, approximately within the first hour. The concentration of fluorescence reached in the anterior chamber at any time is a function not only of the unbound plasma concentration and the permeability of the blood-ocular barriers, but also of the
Brubaker RF. Effect of Continuous Circular Capsulorhexis and Intraocular Lens Fixation on the Blood-Aqueous Barrier. Arch Ophthalmol. 1993;111(5):580-581. doi:10.1001/archopht.1993.01090050014003