Effect of Acrylic Monofocal Intraocular Lenses (IOLS) on ND:YAG Laser Capsulotomy Rates: A Meta-Analysis

Abstract

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.

Effect of AcrySof versus other intraocular lens properties on the risk of Nd:YAG capsulotomy after cataract surgery: A systematic literature review and network meta-analysis

“…The effectiveness of hydrophobic acrylic and hydrophilic acrylic IOLs was compared in two recently conducted meta-analyses of RCTs, whereby the reported Nd:YAG capsulotomy rates were lower for the hydrophobic acrylic group [8, 13]. Furthermore, in a head-to-head meta-analysis, AcrySof IOLs were associated with a significantly lower risk of Nd:YAG capsulotomy compared to other acrylic IOLs [43]. Unlike an NMA, these meta-analyses included only direct evidence for their comparison.…”

“…Further to evidence from RCTs, similar results from observational research have been reported. In Ursell et al (2018), the authors assess AcrySof versus groups of other hydrophobic and hydrophilic IOLs, concluding that the risk of undergoing an Nd:YAG capsulotomy is significantly lower when AcrySof IOLs are used [43].…”