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Clinical consequences of acrylic intraocular lens material and design: Nd:YAG-laser capsulotomy rates in 3 x 300 eyes 5 years after phacoemulsification
  1. Bjorn Johansson*
  1. Department of Ophthalmology, Linköping University Hospital, Sweden
  1. Correspondence to: Björn A Johansson, Division of Ophthalmology, Department of Clinical and Experimental Medicine, Linköping University, Department of Ophthalmology, Linköping, SE58185, Sweden; bjorn.johansson{at}


Background/Aims: To investigate the incidence of Nd:YAG-laser treatment for posterior capsular opacification (PCO) over a period of five years from phacoemulsification in an unselected population, comparing outcomes for three acrylic intraocular lenses (IOLs).

Methods: Retrospective longitudinal cohort study comprising 900 eyes. Three subgroups of 300 eyes, receiving the AR40, AR40e (Abbott Medical Optics, Santa Ana, CA, USA), or BL27 (Bausch & Lomb, Rochester, NY, USA) IOL respectively, were compared. Data on patient age, gender, IOL type, dates of cataract surgery, Nd:YAG-laser treatment and/or death, and visual acuities before/after cataract surgery/Nd:YAG-laser treatment was collected from five sources: cataract operation register, patient administration system, quality control system for cataract operations, Nd:YAG-laser treatment register, and clinical patient records.

Results: 216 eyes (24%) received Nd:YAG-laser treatment over a five-year period. Statistically significant differences (P<0.001, χ 2-test) were found between treatment rates for the three IOLs: AR40 73 eyes (24%), BL27 91 eyes (30%), and AR40e 52 eyes (17%). Eyes of patients that died during the follow-up period had fewer treatments (23/266, 8.6%) than eyes of patients living (193/634, 30%) at the end of the follow-up period.

Conclusion: In comparison with a hydrophobic acrylic IOL with sharp posterior optic edge, a hydrophilic acrylic IOL was associated with almost twice the number of Nd:YAG-laser treatments over the five-year period. The results are useful for discussing the economic long-term consequences of choosing an IOL with a design that makes PCO development more or less likely. Caution is advised when applying data from post-mortem PCO studies on living populations.

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