Objective The purpose of this study was to evaluate the impact of different intraocular lens materials (IOL) and optic edge designs on the incidence of Nd:YAG laser capsulotomy. Methods Randomized controlled trials (RCTs) reporting incidence of Nd:YAG capsulotomy in patients with monofocal IOLs were identified for systematic literature review (SLR) using Cochrane methodology. A network meta-analysis was conducted under a Bayesian framework. Mean hazard ratios (HRs), 95% credible intervals, and one-sided p-values were estimated for Nd:YAG capsulotomy incidence by comparing AcrySof IOLs with a group of non-AcrySof hydrophobic acrylic, hydrophilic acrylic, silicone, and PMMA IOLs. Sensitivity analysis was conducted comparing the risk of Nd:YAG capsulotomy between sharp- and round-edged designs of the above IOLs. Results AcrySof IOLs had a lower risk of Nd:YAG capsulotomy compared to hydrophobic acrylic (HR: 2.68; 95% CrI: 1.41, 4.77; p < 0.01), hydrophilic acrylic (HR: 7.54; 95% CrI: 4.24, 14.06; p < 0.001), PMMA (HR: 3.64, 95% CrI: 1.87, 6.33; p < 0.001), and silicone (HR: 1.13; 95% CrI: 0.59, 1.91; p <0.1) IOLs. The risk for Nd:YAG was highest among sharp-edged IOLs for hydrophilic acrylic IOLs (HR: 9.32; 95% CrI: 4.32, 19.29; p < 0.01), followed by other hydrophobic acrylic (HR: 2.91; 95% CrI: 1.27, 5.88; p < 0.01), silicone (HR: 0.838; 95% CrI: 0.328, 1.74; p = 0.69), and PMMA (HR: 0.39; 95% CrI: 0.042, 1.49; p = 0.93) IOLs, compared to AcrySof. Acrysof IOLs had a lower risk of Nd:YAG compared to PMMA (HR: 3.25; 95% CrI: 1.21, 7.37; p < 0.01) and silicone, round edge IOLs (HR: 3.84; 95% CrI: 1.08, 10.64; p = 0.015). Conclusion The risk of Nd:YAG capsulotomy is lower in eyes implanted with AcrySof IOLs compared to non-AcrySof hydrophobic or hydrophilic acrylic IOLs. Sharp-edged AcrySof, PMMA, and silicone IOLs are comparable in terms of reducing the risk of Nd:YAG laser capsulotomy.

OBJECTIVES: Posterior capsular opacification (PCO) is the most common complication after cataract surgery and its development is associated with several factors, including lens material and design of implanted intraocular lens (IOL). Nd:YAG laser capsulotomy is the only effective treatment for PCO, however, the procedure places a financial burden on health care systems and has been shown to be associated with a number of complications. A systematic literature review (SLR) was conducted to complile evidence on the complications associated with Nd:YAG capsulotomy for PCO after cataract surgery. METHODS: A systematic literature search was conducted on Embase®, MEDLINE®, MEDLINE®-In Process, and Cochrane from January 1996 through August 2017. Articles were selected if they included age-related cataract patients, monofocal IOL implantation for cataract surgery and underwent Nd:YAG capsulotomy for PCO. Complications asssociated with Nd:YAG capsulotomy reported in both RCTs and non-RCTs were reviewed. RESULTS: 19 studies in total (16 non-RCTs and 3 RCTs) fulfilled the inclusion criteria. In non-RCTs, reports of retinal detachment (6 studies) ranged from 0.31% to 7.6%. While incidence of cystoid macular edema (CME) (5 studies) ranged from 0.2% to 7.9%. The included RCTs reported IOL pitting between 14.8% and 19.2%. One RCT reported the incidence of CME (5.8%), retinal detachment (2.5%), increased IOP (12.5%), and uveitis (10%). Other complications reported were as follows: Hyaloid phase rupture, corneal burn, hyphema, posterior vitreous detachment, vitreous in anterior chamber, severe PCO due to high laser energy and vitreous prolapse. CONCLUSIONS: The available evidence confirms that treatment of PCO with Nd:YAG is associated with a notable clinical burden due to complications associated with the procedure, such as retinal detachment and CME. Therefore, reducing the requirement for Nd:YAG capsulotomy to treat PCO, via the correct choice of IOL, will subsequently play a role in improving health outcomes for cataract patients, while translating into savings for national healthcare systems.

A575Objectives: Cataract surgery is the most frequently performed surgical operation in the EU and Nd:YAG laser capsulotomy, a procedure to treat posterior capsular opacification (PCO), is the most commonly reported complication after cataract surgery. The aim of this study was to investigate the incidence of Nd:YAG laser capsulotomy reported in the literature for hydrophobic monofocal AcrySof® IOLs versus non-AcrySof monofocal acrylic IOLs (hydrophilic and hydrophobic). MethOds: Randomized controlled trials (RCTs) were identified through a systematic literature search using Embase®, MEDLINE®, MEDLINE®-In Process, and Cochrane platforms (January 1996 through July 2016). Meta-analyses evaluating the incidence of Nd:YAG capsulotomy at ≤ 1 year, between 1 and 2 years, and > 2 years were conducted comparing AcrySof® IOLs versus non-AcrySof hydrophilic and hydrophobic acrylic IOLs. Subgroup analyses were also conducted between groups. Results: 17 RCTs met the inclusion criteria and were included in the main analysis. AcrySof® IOLs had significantly lower Nd:YAG capsulotomy rates at 1-2 years post-surgery (OR, 0.09; 95%-CI, 0.05 -0.17; p< 0.05) and > 2 years (OR, 0.33; 95%-CI, 0.16 -0.69; p< 0.05) compared to non-AcrySof acrylic IOLs. In the subgroup analysis, AcrySof® IOLs had significantly lower Nd:YAG capsulotomy rates compared to hydrophilic acrylic IOLs at 1-2 years (OR, 0.09; 95%-CI, 0.04 -0.17; p< 0.05) and > 2 years (OR, 0.09; 95%-CI, 0.02 -0.49; p< 0.05). A similar trend was observed vs. non-AcrySof hydrophobic IOLs at > 2 years post-surgery. However, this analysis was limited to a low number of studies (n= 3) and the observed difference did not reach statistical significance (OR, 0.60; 95%-CI,0.25-1.43; p= > 0.05). cOnclusiOns: AcrySof® IOLs are associated with a significantly lower incidence of Nd:YAG capsulotomy compared to non-AcrySof acrylic IOLs (hydrophilic and hydrophobic) and hydrophilic acrylic IOLs at ≥ 2 years, postcataract surgery. Regarding the incidence of Nd:YAG capsulotomy, further research comparing AcrySof® IOLs to non-AcrySof hydrophobic acrylic IOLs is warranted.

is one of the important outcomes that may predict overall survival (OS) in cancer patients. This study examined the association of OS and HRQoL measured before (T0), after cancer diagnosis (T1), and HRQoL changes from T0 to T1 (T1-T0) in patients diagnosed with bladder cancer (BC). Methods: This longitudinal retrospective cohort study used the 1998-2013 Surveillance, Epidemiology and End Results (SEER) database linked with Medicare Health Outcomes Survey (MHOS). HRQoL was measured using the SF-36 (1998-2005)/ Veterans Rand-12 (2006 onwards) and reported as physical (PCS), mental (MCS) component scores, and 8 domain scores. Adjusted hazard ratios (aHRs [95%CI]) were estimated using multivariable logistic regression models, adjusting for demographics, comorbidities, and cancer specific characteristics. Results: 438 BC patients aged $65 years who had HRQoL data at both T0 and T1 were identified. Among those, 220 (50.2%) died and 218 (49.8%) remained alive (censored). Compared to deceased patients, the censored patients were younger (75.366.0 vs. 77.266.8 years; p,0.01), had longer OS (90.4639.9 vs. 67.9642.0 months; p,0.001), had a lower-stage tumor at diagnosis (p,0.001), and had non-invasive tumors (p,0.01). Risk of death was negatively associated with increased PCS at T0 and T1 (aHR T0 =0.984 [0.970-0.998] and aHR T1 =0.976 [0.962-0.990], respectively). At T1, 6 out of 8 domain scores were also significantly associated with OS. However, PCS T1-T0 and MCS at T0, T1, and T1-T0 were not associated with risk of death. Conclusions: We found that PCS was significantly associated with OS in older BC patients in our sample, which implies that older BC patients with better physical health are more likely to survive longer. Therefore, if HRQoL is measured in a routine cancer care, clinicians will be able to intervene early in order to improve or maintain patient's physical health.

OBJECTIVES: Posterior capsular opacification (PCO) is the most common complication after cataract surgery and its development is associated with several factors, including lens material and design of implanted intraocular lens (IOL). Nd:YAG laser capsulotomy is the only effective treatment for PCO, however, the procedure places a financial burden on health care systems and has been shown to be associated with a number of complications. A systematic literature review (SLR) was conducted to complile evidence on the complications associated with Nd:YAG capsulotomy for PCO after cataract surgery. METHODS: A systematic literature search was conducted on Embase®, MEDLINE®, MEDLINE®-In Process, and Cochrane from January 1996 through August 2017. Articles were selected if they included age-related cataract patients, monofocal IOL implantation for cataract surgery and underwent Nd:YAG capsulotomy for PCO. Complications asssociated with Nd:YAG capsulotomy reported in both RCTs and non-RCTs were reviewed. RESULTS: 19 studies in total (16 non-RCTs and 3 RCTs) fulfilled the inclusion criteria. In non-RCTs, reports of retinal detachment (6 studies) ranged from 0.31% to 7.6%. While incidence of cystoid macular edema (CME) (5 studies) ranged from 0.2% to 7.9%. The included RCTs reported IOL pitting between 14.8% and 19.2%. One RCT reported the incidence of CME (5.8%), retinal detachment (2.5%), increased IOP (12.5%), and uveitis (10%). Other complications reported were as follows: Hyaloid phase rupture, corneal burn, hyphema, posterior vitreous detachment, vitreous in anterior chamber, severe PCO due to high laser energy and vitreous prolapse. CONCLUSIONS: The available evidence confirms that treatment of PCO with Nd:YAG is associated with a notable clinical burden due to complications associated with the procedure, such as retinal detachment and CME. Therefore, reducing the requirement for Nd:YAG capsulotomy to treat PCO, via the correct choice of IOL, will subsequently play a role in improving health outcomes for cataract patients, while translating into savings for national healthcare systems.