Effect of AcrySof versus silicone or polymethyl methacrylate intraocular lens on posterior capsule opacification.

OBJECTIVE

To investigate the effect of AcrySof intraocular lenses (IOLs) on the development of posterior capsule opacification (PCO) compared with silicone or polymethyl methacrylate (PMMA) IOLs for patients with senile cataracts.

DESIGN

Meta-analysis of randomized controlled trials (RCTs).

PARTICIPANTS

Patient data from previously reported RCTs.

METHODS

A comprehensive literature search was performed using the Cochrane Collaboration methodology to identify RCTs comparing AcrySof with silicone or PMMA IOLs in patients with senile cataract. A meta-analysis was performed on the results of RCTs.

MAIN OUTCOME MEASURES: Posterior capsule opacification score, neodymium:yttrium-aluminum-garnet (Nd:YAG) capsulotomy rate, and best-corrected visual acuity (BCVA) of 0.5 or better after cataract surgery.

RESULTS

In total, 10 RCTs involving 1202 eyes with senile cataract were included in this meta-analysis. The results suggested that AcrySof had lower PCO scores than round-edged silicone IOLs (standard mean difference [SMD], -0.25; 95% confidence interval [CI], -0.42 to -0.08; P = 0.003) and a somewhat higher PCO score than sharp-edged silicone IOLs (SMD, 0.48; 95% CI, 0.29-0.68; P<0.00001). AcrySof had a lower Nd:YAG capsulotomy rate than round-edged silicone IOLs (odds ratio [OR], 0.29; 95% CI, 0.14-0.62; P = 0.001) and did not differ from sharp-edged IOLs (OR, 1.72; 95% CI, 0.23-13.13; P = 0.60). AcrySof had a lower PCO score (SMD, -1.07; 95% CI, -1.29 to -0.85; P<0.00001) and a lower Nd:YAG capsulotomy rate (OR, 0.09; 95% CI, 0.04-0.20; P<0.00001) than round-edged PMMA IOLs. Furthermore, there was no significant difference in BCVA between AcrySof and round-edged silicone IOLs (OR, 2.28; 95% CI, 0.66-7.82; P = 0.19) or PMMA IOLs (OR, 3.20; 95% CI, 0.78-13.16; P = 0.11).

CONCLUSIONS

AcrySof and sharp-edged silicone IOLs are similarly effective in inhibition of PCO after cataract surgery. In patients implanted with the AcrySof lens, significantly less PCO developed than in those who had round-edged silicone or PMMA IOLs. The results of this meta-analysis support the theory that a major factor in preventing PCO development is a sharp-edged IOL design.