OBJECTIVES: Patients post-cataract surgery may experience abnormal proliferation of lens epithelial cells on the posterior capsule (posterior capsule opacification, PCO). Neodymium-doped yttrium aluminium garnet (Nd:YAG) laser capsulotomy is considered a safe surgical treatment for PCO, but could occasionally lead to further complications. Existing studies have reported numerous factors influencing PCO incidence including IOL material and design. In this study, real-world incidence of both PCO and Nd:YAG in the 5 years post-cataract surgery were assessed in a large UK population, including their association with IOL material.

METHODS: Patients (≥65 years) undergoing cataract surgery with ‘in-the-bag’ placement of acrylic monofocal single-piece IOLs between 2010-2013 were included. Data were collected from Electronic Medical records (EMR) from 7 UK NHS Ophthalmic clinics; only IOL models used in at least 500 procedures were included. The analysis focused on the association between the IOL model and the risk of PCO and Nd:YAG. Incidence proportion of PCO and Nd:YAG at 5 years from cataract surgery was calculated for each IOL model. Pairwise comparisons were conducted between AcrySof IOLs and other IOLs using Bonferroni adjustment for multiplicity. Multivariate analyses were also conducted adjusting for known confounders.

RESULTS: Incidence proportion of Nd:YAG at 5 years post-cataract surgery was 5.8% for AcrySof (CI 5.2%-6.4%, n=5,342); this was significantly lower than Tecnis (8.5%, CI 7.8%-9.2%, n=5,609), B&L (15.2%, CI 14.3%-16.0%, n=6,847) and Lenstec (19.3%, CI 17.9%-20.8%, n=2,964) (all P values <0.001). AcrySof IOLs also had significantly lower incidence proportion of PCO compared with the other IOLs.

CONCLUSIONS: This real world evidence study demonstrated that hydrophobic single-piece AcrySof IOLs are associated with a significantly lower incidence of Nd:YAG capsulotomy and PCO post cataract surgery, at a long-term follow-up of five years.