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Secondary barrier failure more frequent with acrylic than silicone IOLs
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PARIS — Among the many factors that are involved in posterior capsular opacification prevention, the use of silicone material seems to play a crucial role, according to a speaker here.
"In the long term, silicone seems to prevent posterior capsular opacification better than acrylic," Rupert Menapace, MD, said at the meeting of the European Society of Cataract and Refractive Surgeons.
One prerequisite for the formation of an effective edge barrier is establishing a circumferential rhexis-optic overlap during surgery, he said.
Adaptation of the lens to the capsular bag to maximize the contact angle, sharpen posterior edges and slim optic junctions are all elements that contribute to creating an effective barrier effect, Dr. Menapace said.
"In the long term, the IOL material's fibrogenetic potential is crucial, and acrylics seem to be prone to secondary barrier failure more than silicone," Dr. Menapace said.
In other words, the strength of collagenous sealing at the fusion line along the optic circumference appears to be less with acrylic IOLs. At around 3 years to 5 years following implantation, the mechanical force of Soemmering's ring may force open the fusion line and annihilate the bend at the posterior optic edge, allowing dormant LECs to resume migrating and proliferating beneath the optic, he explained.
The same does not happen with silicone IOLs. They appear to provide a more adequate long-term collagenous sealing of the fusion line, resulting in a lower rate of secondary barrier failure, he said.