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Sharp-edge acrylic and silicone IOLs better prevent PCO, meta-analysis confirms
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Acrylic and silicone IOLs better prevent the formation of posterior capsular opacification necessitating Nd:YAG laser capsulotomy, according to a meta-analysis of 23 comparative studies.
Jin-Wei Cheng, MD, and colleagues at Changzheng Hospital in Shanghai, China, identified studies listed in the Cochrane library, MEDLINE and Embase databases for their analysis. Of the 23 studies reviewed, 14 trials compared different biomaterials, seven compared optic edge designs and two compared both biomaterials and optic edge designs. Follow-up ranged from 12 to 62.5 months, according to the study.
Five trials involving 987 eyes compared acrylic IOLs and PMMA IOLs. The researchers found that eyes implanted with acrylic IOLs were 24% less likely to undergo Nd:YAG laser capsulotomy.
Eight studies involving 826 eyes compared silicone IOLs with PMMA lenses and found that silicone lenses were "significantly more effective" than PMMA lenses for reducing capsulotomy rates. Silicone IOLs were associated with a 9% lower rate of capsulotomies compared with PMMA IOLs, according to the study.
Seven trials involving 939 eyes found that silicone and acrylic lenses were equally effective. However, three trials found a 14% lower capsulotomy rate for silicone IOLs vs. the acrylic lenses, the authors reported.
Hydrogel IOLs were also statistically similar to PMMA lenses, but were associated with a 28% higher capsulotomy rate compared with silicone lenses and a 19% higher rate compared with acrylic lenses, according to the study.
One trial of PMMA lenses found that sharp-edge optic designs more effectively prevented posterior capsular opacification (PCO) than the rounded-edge optics. In contrast, two trials of acrylic IOLs found both sharp-edge and round-edge lenses equally effective for reducing capsulotomy rates, although a third trial found sharp-edge acrylic lenses were more effective than rounded-edge lenses.
Five trials showed silicone lenses with a sharp edge were more effective than rounded-edge silicone lenses for preventing capsulotomy. Another four trials found sharp-edge silicone IOLs were more effective than rounded-edge silicone lenses for prevention of PCO, according to the study.
The authors noted that additional controlled trials with at least 5 years' follow-up are needed to better evaluate the efficacy of lens materials and optic design in preventing PCO and reducing capsulotomy rates.
The study is published in the March issue of the American Journal of Ophthalmology.