Over a 1.5-year postoperative period, surface precipitates were observed on hydrogel intraocular lenses (IOLs) by specular microscopy. In eyes with prolonged postoperative inflammation, a higher number of cells was observed. In these cases, the cells remained on the IOL surface for a longer period. We found very few small round cells and fibroblast-like cells on hydrogel IOLs during the postoperative period of our follow-up. Only in 8% (16 eyes) foreign-body giant cells were observed. From these 16 eyes, 81.25% showed an increased postoperative inflammation due to a preexisting inflammatory disposition or increased intraoperative trauma. In eyes, where a glaucoma or a corneal triple procedure was performed, foreign-body giant cells were seen in 27.3 or 10%, respectively. Fifty percent of these 16 eyes showed postoperative iridocapsular synechiae. These data show that an increased postoperative inflammation or iridocapsular synechiae cause cell reaction in most of the cases. Excluding all these cases, foreign-body cells were seen in only 1.5% on hydrogel IOLs. These results suggest that p-Hema is a material with high biocompatibility. In 43.5%, we found pigment deposits on the surface of hydrogel IOLs. These pigment granules induced almost no cell reaction with almost no phagocytosis of the pigment debris. In 7% of the cases, dust-like white precipitates of uncertain origin were seen on the IOL surface and posterior capsule; in 5%, amorphous debris was observed. Fine scratches, obviously caused by the polishing process during manufacture, were seen on the hydrogel IOLs.