OBJECTIVES: Posterior capsular opacification (PCO) is most common complication of cataract surgery and can cause impaired contrast sensitivity and glare disability. Nd:YAG laser capsulotomy, which is considered a proxy measure for clinically significant PCO, is the only effective treatment for the complication but carries vision-related risks and places a financial burden on health care systems. Intraocular lens (IOL) material has been shown to influence PCO development. The purpose of this study was to evaluate the impact of different IOL materials on the incidence of Nd:YAG laser capsulotomy.

METHODS: A systematic review was performed between January 1996 and August 2017 through both Embase® and Ovid® platforms, to identify RCTs reporting incidence of Nd:YAG capsulotomy in patients implanted with monofocal IOLs. A network meta-analysis (NMA) was thus conducted under a Bayesian framework. Mean HRs, 95% credible intervals (CrI), and one-sided p-values were estimated for the incidence of Nd: YAG capsulotomy by comparing AcrySof IOLs with a group of non-AcrySof hydrophobic acrylic, hydrophilic acrylic, silicone, and PMMA IOLs.

RESULTS: Data from 37 RCTs were included in the NMA. AcrySof IOLs had a lower risk of Nd:YAG capsulotomy vs non-AcrySof hydrophobic acrylic (HR: 2.97; 95% CrI: 1.26, 6.19; p < 0.01), hydrophilic acrylic (HR: 9.07; 95% CrI: 4.22, 18.7; p < 0.001), PMMA (HR: 2.37, 95% CrI: 0.95, 4.99; p = 0.03), and silicone (HR: 1.2; 95% CrI: 0.509, 2.34; p = 0.38) IOLs.

CONCLUSIONS: The NMA presents strong evidence to suggest that the risk of Nd:YAG capsulotomy is lower in eyes implanted with AcrySof IOLs compared to non-AcrySof hydrophobic or hydrophilic acrylic IOLs. The appropriate choice of IOL for cataract surgery is an important consideration to minimize the risk of Nd:YAG laser capsulotomy post cataract surgery and may translate into significant savings for national healthcare systems and also reduce the clinical risks associated with the procedure.