Multiple Pit Defects in a Foldable Hydrophobic Intraocular Lens

We are writing to share our observations regarding the article “Multiple pit defects of unknown etiology in a foldable hydrophobic intraocular lens” by Thabit et al.[1] We would like to congratulate the authors for documenting this interesting phenomenon. The authors mentioned no obvious reason for the formation of pit-like deposits on the anterior surface of the intraocular lens (IOL). We want to disagree with this statement in that IOL pit formation is a well-established phenomenon where opacification of hydrophilic acrylic IOLs occurs after corneal transplantations such as penetrating keratoplasty and Descemet’s stripping endothelial keratoplasty (DSEK).[2] Factors such as ocular inflammation and systemic comorbidities that affect ocular metabolism may contribute to the opacification of IOLs.[3] Surgical interventions with the injection of different materials into the anterior chamber such as air or gas seem to increase the risk of IOL opacification, particularly in hydrophilic IOLs. The pits are limited to a more or less circular area of the anterior optical surface of the IOL corresponding to the zone of contact with the instilled air or gas.