Association between intraocular lens diopter and posterior capsular opacification

Abstract

Importance: Posterior capsular opacification (PCO) is the most common complication after cataract surgery. Background: We aimed to assess the relationship between intraocular lens (IOL) diopter and formation of PCO among a consecutive real-world registry. Design: Cohort study. Participants: Included were 14 264 consecutive cases of uncomplicated cataract surgery performed during 2014 to 2018 in Helsinki University Hospital in Finland. Methods: Nd:YAG capsulotomies were used as an estimate of clinically significant PCO. A single eye of each patient and a single type of IOL were included. Main Outcome Measure: Nd:YAG posterior capsulotomy free survival. Results: Mean age was 73.2 ± 9.9 years and 61.8% were female. Mean followup time was 25.4 ± 16.8 months. Overall PCO rates were 1.1% at 1-year, 3.0% at 2-year, 7.1% at 3-year and 10.2% at 4-year. Patients with IOL diopters (D) in the lower quartile (≤20.0 D) had significantly higher rates of PCO (1.3% at 1-year, 4.4% at 2-years, 9.4% at 3-years and 14.2% at 4-years, P < .001). A logistic regression model showed increased risk for PCO formation with lower diopter IOLs; for ≤20.0 D: OR 1.343 (95% CI: 1.132-1.593), for ≤10.0 D: OR 2.409 (95% CI 1.203-4.287), P < .001 for all comparisons. In a multivariant regression accounting for possible confounders, results remained consistent. Conclusions and Relevance: Among a cohort of patients undergoing cataract surgery, use of lower diopter IOLs was associated with increased incidence of clinically significant PCO. Research into IOL biomechanics to decrease PCO may be warranted especially in lower diopter IOLs.

Long-Term Clinically Significant Posterior Capsular Opacification Development Pattern in Eyes Implanted with an Aspheric Monofocal Intraocular Lens with a Square Optic Edge

“…It should be considered that the number of cases completing a follow-up of more than 7 years was reduced. This trend was consistent with the findings of other studies showing similar PCO progression rates [ 8 , 25 , 28 ]. Hecht and coauthors [ 8 ] showed for a specific model of hydrophobic IOL that the PCO rate increased from 1.1% at 1 year after surgery to 7.1% and 10.2% at 3 and 4 years, respectively.…”

“…This trend was consistent with the findings of other studies showing similar PCO progression rates [ 8 , 25 , 28 ]. Hecht and coauthors [ 8 ] showed for a specific model of hydrophobic IOL that the PCO rate increased from 1.1% at 1 year after surgery to 7.1% and 10.2% at 3 and 4 years, respectively. Praveen et al [ 28 ] reported a significant increase of PCO rate for a hydrophobic acrylic IOL during the first 3 years after surgery, with a more limited increase afterwards.…”

“…Auffarth et al [ 24 ] reported in a multicenter study a 3-year laser capsulotomy rate of 31.1% for a specific model of hydrophilic acrylic IOL. Furthermore, the laser capsulotomy rates of the sample evaluated were similar to those reported for some models of hydrophobic IOLs [ 5 , 8 , 25 ] but higher than those reported for some other models of hydrophobic acrylic IOLs [ 6 , 10 , 21 , 24 , 26 , 27 ]. Hecht et al [ 8 ] found in a large population study (14,264 cases) a Nd : YAG capsulotomy rate for a square edge hydrophobic IOL increasing from 1.1% at 1 year after surgery to 10.2% at 4 years postoperatively.…”

“…Furthermore, the laser capsulotomy rates of the sample evaluated were similar to those reported for some models of hydrophobic IOLs [ 5 , 8 , 25 ] but higher than those reported for some other models of hydrophobic acrylic IOLs [ 6 , 10 , 21 , 24 , 26 , 27 ]. Hecht et al [ 8 ] found in a large population study (14,264 cases) a Nd : YAG capsulotomy rate for a square edge hydrophobic IOL increasing from 1.1% at 1 year after surgery to 10.2% at 4 years postoperatively. Ling et al [ 25 ] reported for another type of hydrophobic IOL a Nd : YAG capsulotomy rate increasing from 4.5% at 1 year after surgery to 12% at 3 years.…”

“…This IOL is made of a material combining hydrophobic and hydrophilic monomers. As in other retrospective studies analysing large populations [ 8 ], Nd : YAG capsulotomies were used as an estimate of clinically significant PCO. Indeed, different studies have shown similar percentage of eyes with clinically significant PCO and laser capsulotomy, with only a slight trend to obtain lower values for the Nd : YAG capsulotomy rate.…”