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Concerns expressed over PCO with one-piece IOLs
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SAN FRANCISCO — The haptic-optic junction of some one-piece foldable lenses may provide a platform for cell proliferation onto the IOL optic, several speakers here suggested.
The concern about posterior capsular opacification with some one-piece lens designs, raised recently by Okihiro Nishi, MD, was echoed by a number of speakers at a session here at the American Society of Cataract and Refractive Surgery meeting
Begging the audience, “Don’t kill the messenger,” David J. Apple, MD, said that the Achilles heel of one-piece lenses is the lack of a sharp edge at the point where the haptics join the optic. The rounded edge configuration at these points on the IOL provides a possible route for the migration of lens epithelial cells onto the surface of the optic, he said.
Dr. Apple noted that Dr. Nishi was the first to raise this concern in relation to the bulky haptics of the AcrySof Single-Piece IOL.
Dr. Apple said it is possible to make an IOL with a 360-degree square edge, even with a one-piece design. He said Rayner is now beginning to do this with its CentreFlex one-piece hydrophilic acrylic IOL.
At the same session, Manfred Tetz, MD, described a clinical study performed at his center to try to confirm Dr. Nishi’s hypothesis.
Using an objective scoring system, Dr. Tetz said, researchers compared PCO in eyes implanted with the Single-Piece AcrySof to eyes with the Multi-Piece AcrySof. The EPCO system rates PCO on a scale of 0 to 4, with 4 being the highest.
Surprisingly, he said, the results favored the one-piece lens. At 1 year postop, both types of lens had very low PCO scores, but the one-piece lenses had a lower mean score than the three-piece.
So Dr. Tetz said it remains to be seen whether the theoretical risk of increased PCO in one-piece lenses will be borne out in clinical practice.