Original article
Efficacy of Different Intraocular Lens Materials and Optic Edge Designs in Preventing Posterior Capsular Opacification: A Meta-Analysis

https://doi.org/10.1016/j.ajo.2006.11.045Get rights and content

Purpose

To evaluate the efficacy of different intraocular lens (IOL) materials and optic edge designs in preventing posterior capsular opacification (PCO).

Design

Systematic review and meta-analysis.

Methods

Pertinent studies were selected through an electronic search of the Cochrane Library, MEDLINE, and Embase. The randomized controlled trials meeting the predefined criteria were reviewed systematically by meta-analysis. The treatment effects were measured as risk difference, and the pooled estimates were computed according to a random effect model.

Results

In total, 23 randomized controlled trials were included in the present meta-analysis. The pooled risk differences of Nd:YAG laser capsulotomy rates were −24% (95% confidence interval [CI], −29% to −20%) comparing acrylic with polymethylmethacrylate (PMMA) lenses; −9% (95% CI, −17% to −1%) comparing silicone with PMMA lenses; 14% (95% CI, −8% to 36%) comparing hydrogel with PMMA lenses; 4% (95% CI, −2% to 10%) comparing silicone with acrylic lenses; 19% (95% CI, 8% to 30%) comparing hydrogel with acrylic lenses; and 28% (95% CI, 10% to 46%) comparing hydrogel with silicone lenses. The pooled risk differences of PCO rates were −39% (95% CI, −47% to −31%) comparing acrylic with PMMA lenses; −14% (95% CI, −29% to 0%) comparing silicone with acrylic lenses; 56% (95% CI, 36% to 75%) comparing hydrogel with acrylic lenses; and 48% (95% CI, 31% to 64%) comparing hydrogel with silicone lenses. When comparing sharp with rounded-edge designs, pooled risk differences of capsulotomy rates were −47% (95% CI, −77% to −17%) in PMMA lenses, −22% (95% CI, −47% to 2%) in acrylic lenses, and −9% (95% CI, −17% to 0%) in silicone lenses; pooled risk differences of PCO rates were −28% (95% CI, −50% to −7%) in acrylic lenses and −37% (95% CI, −46% to −27%) in silicone lenses.

Conclusions

The rates of PCO and Nd:YAG laser capsulotomy may be influenced by different IOL biomaterials and optic edge designs. The lenses made by acrylic and silicone and those with sharp optic edges are superior in lowering the rates of PCO and laser capsulotomy.

Section snippets

Methods

We followed the widely accepted methodologic recommendations in the present meta-analysis, which was performed according to a predetermined protocol.8, 9, 10 The main outcome measures included the rates of PCO and Nd:YAG laser capsulotomy.

Results

Twenty-nine potentially relevant publications were identified through the literature search.4, 5, 6, 7, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37 Among these, 23 randomized controlled trials met our criteria and were included in the present meta-analysis, with 14 that compared different biomaterials,4, 5, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30 seven that compared different optic edge designs,6, 7, 31, 32, 33, 34, 35 and two that

Discussion

Posterior capsule opacification remains the most common cause of visual failure after successful cataract surgery. It is well known that PCO is caused by migration and proliferation of the residual lens epithelial cells (LECs) onto the central region of the posterior capsule.38 If the LECs could be removed completely, we would most likely avoid PCO. Unfortunately, complete surgical removal is impossible at present. Consequently, there is considerable interest in better ways to prevent this

Jin-Wei Cheng, MD, has been a physician at the Department of Ophthalmology, Changzheng Hospital, Second Military Medical University, since 2005. Dr Cheng has taught ophthalmology for medical students at the Second Military Medical University, since 2003. He has won the “the Medical Science Prize of Second Military Medical University” in 2005 and “the Science & Technology Prize of Shanghai Municipal Government”, in 2006. Dr Cheng’s research interests include cataract surgery, glaucoma surgery,

References (38)

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    Citation Excerpt :

    Furthermore, they undergo epithelial to mesenchymal transformation resulting in a more fibroblastic phenotype which leads to contraction of the posterior capsule causing capsular wrinkling with increasing light scattering and a reduction in visual acuity [3–5]. Established risk factors are age, gender, dry eye disease, glaucoma, uveitis, age-related macular degeneration, hyperlipidemia [6], diabetic and inflammatory comorbidity [7], intraocular lens (IOL) design and material [8,9], surgical technique and surgeon experience [10]. Although IOL design (sharp-edge [11]), materials and surgical techniques have been significantly improved over the years [12], over long-term observation, PCO incidence remains frequent, and has to be treated by neodymium-doped yttrium aluminum garnet (Nd:YAG or Nd:Y3Al5O12) laser capsulotomy [13,14].

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Jin-Wei Cheng, MD, has been a physician at the Department of Ophthalmology, Changzheng Hospital, Second Military Medical University, since 2005. Dr Cheng has taught ophthalmology for medical students at the Second Military Medical University, since 2003. He has won the “the Medical Science Prize of Second Military Medical University” in 2005 and “the Science & Technology Prize of Shanghai Municipal Government”, in 2006. Dr Cheng’s research interests include cataract surgery, glaucoma surgery, and orbital surgery.

Rui-Li Wei, MD, a Professor of Ophthalmology, is the head of the Department of Ophthalmology, Changzheng Hospital, Second Military Medical University. Dr Wei is listed as a member of the editorial boards of the Chinese Journal of Practical Ophthalmology, the Chinese Journal of Optometry & Ophthalmology, and the Chinese Journal of Cancer Prevention and Treatment. He is also the committee secretary of the Shanghai Association of Ophthalmology. Dr Wei’s research interests include cataract surgery, after-cataract prevention, glaucoma surgery, and orbital surgery.

Supplemental Material available at AJO.com.

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