Pmd3 - Methods for Quantifying Posterior Capsular Opacification and the Impact of Intraocular Lens Material on Severity Scores - A Systematic Literature Review

Abstract

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.