This study compares the incidence of significant posterior capsular opacification in the 12 months following surgery in patients who received a sulcus-fixated silicone lens, a bag-fixated poly(methyl methacrylate) (PMMA) lens, or a bag-fixated silicone lens. All procedures were performed by the same surgeon using the same technique. The incidence of capsulotomy was 16.5% with sulcus-fixated silicone lenses, 7.9% with PMMA lenses, and 4.8% with bag-fixated silicone lenses. This confirms the impression that earlier opacification occurs with sulcus-fixated silicone lenses, but the low incidence of opacification with bag-fixated silicone lenses suggests the cause is not the silicone but the location of lens fixation.