Effect of four different intraocular lenses on posterior

capsule opacification

Naim Ismail ImunuKepaniteraan Klinik Ilmu Kesehatan Mata

RSUD R. Soedjati Purwodadi

Introduction

Cataract Surgery

Posterior Capsule Opasification Surgery Method

Laser Nd:YAG

Material of IOLs

Subject and Methods• Study Population

– Data was collected retrospectively for 4970 consecutive eyes of 4013 patients

• Inclusion– patients with senile cataract who underwent uncomplicated

phacoemulsification surgery and IOL implantation performed by one surgeon (Karel F) at the Ankara University Faculty of Medicine, Department of Ophthalmology between January 2000 and January 2008.

• Exclusion– concomitant ocular pathologies (uveitis or history of uveitis high myopia

(>S-6D )– previous trauma or had suffered any intra operative complication

(capsulorhexis rim tear, zonular rupture, posterior capsule rupture with or without vitreous loss or the usage of the capsule tension ring)

Devided into 4 groups based on 4 different IOLs

• Group 1 :AcrySof SN60AT (Alcon Laboratories, Inc., Fort Worth, TX, USA), 1-piece acrylic hydrophobic IOL with a 6.0 mm optic diameter, a 13.0 mm overall diameter and acrylic haptics angled at 0°, was implanted in 1399 eyes of 1014 patients.

• Group 2 : AcrySof MA30BA (Alcon Laboratories, Inc., Fort Worth, TX, USA), a 3-piece acrylic hydrophobic IOL with a 5.5 mm optic diameter, a 12.5 mm overall diameter and poly methyl metahacrylate (PMMA) haptics angled at 5°, was implanted in 1509 eyes of 1242 patients.

• Group 3 : AcrySof MA60BM (Alcon Laboratories, Inc., Fort Worth, TX, USA), a 3-piece acrylic hydrophobic IOL with a 6.0 mm optic diameter, a 13.0 mm overall diameter and PMMA haptics angled at 10°, was implanted in 1501 eyes of 1324 patients.

• Group 4 : Aqua-SenseTM III (Aaren Scientific Inc.,Ontario, USA) a 3-piece acrylic hydrophilic IOL with a 6.0 mm optic diameter, a 12.5 mm overall diameter and acrylic haptics angled at 5°, was implanted in 561 eyes of 433patients.

Surgeon

• (Karel F)• Ankara University Faculty of Medicine,

Department of Ophthalmology between January 2000 and January 2008

Post operative treatment

• Dexamethason topical 0,1%• Ciprofloxasin topical• 5 time daily for 1mo

Statistical analysis• PCO development associated with each IOLMajor outcome

• Were compared using a Z testThe differences between groups

• assessed using the Chi-square test. A value P less than 0.05 was considered statisticallysignificant.

statistical significance ofdifferences in frequencies

• SPSS 13.0 software SPSS Inc., Chicago, USA)Analysis

RESULT

Mean of age

PCO requiring Nd:YAG laser/% Sign. Mean time PCO

developement Sig.

Group 1 67.90±9.55 41 eyes/2.93% 0,74 13.21±10.02mo 0,001

Group 2 66.90±10.73 41 eyes/2.72% 0,71 33.11±25.06mo

Group 3 69.33±8.44 45 eyes/3.00% 0,71 22.25±16.02mo

Group 4 70.03±9.56 26 eyes4.63% 0,015 39.91±15.52mo 0,001

DISCUSSION

• The incidence of PCO is affected by many factors. • The development of modern foldable IOLs with square-edged optics has greatly

reduced the incidence of PCO following cataract surgery.

recent studies

• The sharp optic edge, now known to be a major inhibitory factor for PCO development

Camparasion of IOLs

material

• The clinical introduction of 1-piece acrylic hydrophobic IOLs with some differences in optic and haptic design was expected to be associated with a different rate of PCO development compared with 3-piece acrylic hydrophobic IOLs.

• 1y after surgery, 1-piece acrylic IOLs are associated with slightly more regeneratory PCO than 3-piece acrylic IOLs made from the same material.

• the modification of an IOL from a 3-piece to a 1-piece haptic design caused no significant change in the development of PCO.

• hydrophilic acrylic lenses provide a suitable environment for lens epithelial cells migration because of the hydrophilic surface properties.

• Previous studies have reported that hydrophobic IOLs are associated with lower rates of PCO than hydrophilic IOLs

IOLs causing

PCO

• According to our results, eyes with acrylic hydrophobic optic IOLs were more likely to require Nd:YAG laser capsulotomy than eyes with acrylic hydropholic optic IOLs.

The needed

of Nd:YAG

laser

Conclusion

• A higher percentage of eyes with hydrophilic acrylic IOLs developed PCO than eyes with acrylic hydrophobic IOLs.

• no significant difference in the long-term PCO rate of a1- or 3-piece hapticlens design.

• Eyes with acrylic hydrophilic IOLs did not require an Nd:YAG laser capsulotomy as soon as eyes with acrylic hydrophobic IOLs.

summary

CRITICALAPPRAISAL

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Apakah penelitian ini penting ?

Penting bagi praktisi

kesehatan mata untuk mengetahui

perkembangan tentang pengaruh

jenis IOLs terhadap

insidensi PCO

Apakah hasil penelitian tersebut

mungkin untuk diterapkan pada

pasien kita ?

Tidak bisa, mengingat

sebagian besar pasien kita BPJS

sehingga opsi untuk jenis lensa

yang spesifik terbatas