I read with interest the article by Lin et al.1 As part of this study, the authors performed a posterior capsulorhexis and used a blunt needle to extract material from the retrolental space using immunohistochemistry to confirm that these substances were lens material. They went on to state that histological evidence proving that these materials are lens fragments “is lacking.”

I would like to bring a published study to the authors' attention, “Materials in the Vitreous during Cataract Surgery: Nature and Incidence, with Two Cases of Histological Confirmation,” for which I served as a coauthor in 2016.2 Under the direction of Dr. Ian Francis, 767 consecutive phacoemulsification cases without capsular rupture or vitreous loss were evaluated in Australia. Materials in the vitreous were observed in either Berger space or in the anterior vitreous in 50.3% of cases the majority represented a lens material, although pigment and ophthalmic viscosurgical device were present in less than 10% of cases. Histological assessment with light microscopy and birefringence techniques identified the materials in the vitreous as lens material.

In the study by Lin et al., retrolental material was present and observed in 36.6% of the 205 surgical cases. Observing lens particles is not uncommon as these likely pass between zonular fibers during the phacoemulsification and cortical removal. The authors of this study speculate that a higher cumulative dissipated energy may cause more trauma to zonular fibers and the Wieger ligament and that prolonged aspiration time can also damage zonular fibers. I agree with the publication by Vasavada et al. in which they hypothesize that a lower infusion pressure is less likely to damage the anterior hyaloid membrane, and I have observed that these particles are less frequent in slow motion phacoemulsification with reduced parameters and lower bottle heights.3–5

While the study by Lin et al. raises the possibility of chronic uveitis due to the presence of autoantigens, our study failed to show evidence of chronic uveitis or vitritis. I do not think that these particles are conducive to complications, although some patients will observe postoperative floaters while others will develop a posterior vitreous detachment soon after surgery. I congratulate the authors for bringing attention to the vitreolenticular interface.

1. Lin W, Luo J, Li P, Ji M, Guan H. Anterior vitreous detachment and retrolental material during cataract surgery: incidence and risk factors, with pathological evidence. J Cataract Refract Surg 2023;49:578–583 2. Kam AW, Chen TS, Wang SB, Jain NS, Goh AY, Douglas CP, McKelvie PA, Agar A, Osher RH, Francis IC. Materials in the vitreous during cataract surgery: nature and incidence, with two cases of histological confirmation. Clin Exp Ophthalmol 2016;44:797–802 3. Vasavada V, Srivastava S, Vasavada V, Vasavada S, Vasavada A, Sudhalkar A, Bilgic A. Impact of fluidic parameters during phacoemulsification on the anterior vitreous face behavior: experimental study. Indian J Ophthalmol 2019;67:1634–1637 4. Osher RH, Marques FF, Marques DM, Osher JM. Slow-motion phacoemulsification technique. Techniq Ophthalmol 2003;1:73–80 5. Osher RH. Slow motion phacoemulsification approach. J Cataract Refract Surg 1993;19:667