Acrylic IOLs may have better long-term compatibility for pediatric cataract

MUNICH, Germany — Acrylic IOLs showed better biocompatibility than two types of PMMA lenses after pediatric congenital cataract surgery, according to a surgeon speaking here.

Marek Prost, MD, of Poland, presented the results of a study comparing four types of IOLs in 85 children ages 1 to 8 years here at the European Society of Cataract and Refractive Surgeons meeting.

Similar surgical techniques were used for cataract removal and lens implantation for each IOL type. Scleral tunnel incisions were used for PMMA lenses and limbal incisions for the acrylic lenses.

Twenty-eight children were implanted with the Rayner 235 U PMMA IOL, 17 received the Pfizer heparin surface modified PMMA 811, 15 received the Alcon AcrySof SA30AL acrylic hydrophobic IOL, and 25 received the Rayner Centerflex acrylic hydrophilic IOL.

To determine the biocompatibility of the lenses, Dr. Prost evaluated percentage of area and number of IOL precipitates and pigment deposits. He also evaluated the degree of iris synechia that developed and the proliferation of lens epithelial cells. A four-level grading system was developed for the study.

Follow-up was performed at 1 day, 2 weeks and 3 months and 1 year postop.

Dr. Prost said the acrylic hydrophilic lenses appeared to have better uveal biocompatibility, but acrylic hydrophobic lenses showed the lowest incidence of lens epithelial cell proliferation.

According to the study, 8% of eyes implanted with the Centerflex showed IOL precipitates, as compared to 26.5% with the AcrySof, 47% with the HSM 811 and 66% with the 235 U.

Pigment deposits were seen in 20% of the Centerflex eyes, 27% of the AcrySof eyes, 47% of the HSM 811 eyes, and 78% of the 235 U eyes.

Regarding lens epithelial cell migration, Dr. Prost said 0.5 units were seen with the AcrySof, 0.9 units with Centerflex, 1.8 with the HSM 811 and 2.8 with the 235 U.