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Larger optic IOL, capsule closure help to prevent PCO, study suggests

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Using a larger optic IOL and completely sealing the anterior capsulorrhexis to the IOL may help prevent posterior capsule opacification, a retrospective study suggests. The study results support the “capsule compression” theory of PCO prevention, the study authors said.

Siobhan M.E. Wren, MRCOphth, and colleagues at St. Thomas’ Hospital in London analyzed a series of sequential images from 60 eyes implanted with the Alcon AcrySof three-piece, 5.5-mm-optic IOL after cataract extraction. Using PCO analysis software, the images were divided into those with greater than or less than 10% PCO. The degree of contact between the capsulorrhexis and the IOL was recorded in clock hours.

Of the 60 eyes, 21 had more than 10% PCO. No correlation was found between PCO and patient age or gender or the eye’s axial length. Forty-eight eyes (80%) had some loss of rhexis-IOL contact. These eyes had increased PCO when compared with the eyes that had complete rhexis-IOL contact. The difference was statistically significant, the researchers said.

Lack of complete contact between the rhexis and anterior IOL surface accounted for “the majority of increased PCO seen in patients implanted with this IOL model,” the study authors reported in the April issue of the American Journal of Ophthalmology.

PCO formation is also related to surgical technique, they noted, so comparisons of PCO between IOL types must take technique into account.

“It is notable that we found more PCO in those patient groups with between 4 and 9 clock hours of loss of rhexis contact,” the authors said. Previous studies have shown that larger optic IOLs have lower PCO rates, and this may be because it is easier to get the rhexis on the IOL with a larger optic, they noted.

“These results show that the comparative success of an IOL in preventing PCO cannot be judged in isolation from surgical technique,” the authors said.