A multicentre, retrospective cohort study comparing the real-world incidence of Nd:YAG laser capsulotomy procedure to treat posterior capsular opacification in the first 3 years after cataract surgery among hydrophobic and hydrophilic acrylic IOLs

Session Details

Session Title: Cataract Surgery Practice Styles/PCO

Session Date/Time: Tuesday 10/10/2017 | 14:00-16:00

Paper Time: 15:02

Venue: Room 4.4

First Author: : P.Ursell UK

Co Author(s): :    M. Dhariwal   M. Keith   K. Majirska   F. Ender   C. Miglio   S. Rabhi     

Abstract Details

Purpose:

PCO is the commonest complication after cataract surgery. It causes significant visual impairment and often requires treatment with neodymium-doped yttrium aluminium garnet laser capsulotomy (Nd:YAG), with associated risks and costs. The aim of this study is to generate real-world evidence on the incidence of Nd:YAG and PCO over 3 years following age-related cataract surgery, comparing outcomes for hydrophobic monofocal AcrySof IOLs versus a basket of non-AcrySof monofocal acrylic IOLs (hydrophilic and hydrophobic) in a large, multicentre, retrospective cohort.

Setting:

This study is a retrospective analysis of anonymised electronic medical records of cataract patients from a selected sample of 7 NHS (National Health Service) ophthalmology clinics across the UK.

Methods:

Eyes from patients (≥65 years) undergoing cataract surgery with in-the-bag implantation of acrylic monofocal IOLs during 2010-2013 and with ≥3-year follow-up were analysed. At 3 years, Nd:YAG incidence proportions and 95% confidence intervals (CI) were reported for AcrySof IOLs and non-AcrySof IOLs, overall and by hydrophobic and hydrophilic properties. A sensitivity analysis in the sub-group of single-piece IOLs was also performed. Unadjusted/adjusted odds ratios (95% CI) were calculated through multivariate logistic regression for AcrySof versus non AcrySof lenses. Time to Nd:YAG in the two groups was modelled over the 3 years using Kaplan-Meier curves.

Results:

The AcrySof and non-AcrySof groups included 13,330 and 38,832 (hydrophobic: 19,025; hydrophilic: 19,807) eyes, respectively. The 3-year Nd:YAG incidence for AcrySof IOLs (2.4%, CI: 2.2-2.7%) was 2-times lower than for hydrophobic (4.4%, CI: 4.1-4.7%) and 4-time lower than for hydrophilic (10.9%, CI: 10.5-11.3%) non-AcrySof IOLs. Similar trend was found when restricting to single-piece IOLs (2.4% vs 5.1% vs 10.9%, respectively). Overall, AcrySof recorded 70% lower risk of Nd:YAG (adjusted OR 0.29, CI: 0.26-0.33) compared to other non-AcrySof IOLs. The difference in proportions of eyes not undergoing Nd:YAG became apparent after 1.5 years and continued to progress for the non-AcrySof group.

Conclusions:

This study generated robust real-world evidence on the association between IOL materials and post-cataract Nd:YAG capsulotomy procedure to treat PCO. The results indicate that AcrySof single-piece IOLs are protective against PCO and subsequent Nd:YAG treatment compared to other single-piece hydrophobic and hydrophilic acrylic IOLs in the 3 years after cataract surgery. Future studies will confirm these findings over longer follow-up durations and investigate the consequences of lens choice for patient quality of life and overall healthcare costs.

Financial Disclosure:

is employed by a forNONEprofit company with an interest in the subject of the presentation, research is funded, fully or partially, by a company producing, developing or supplying the product or procedure presented, receives consulting fees, retainer, or contract payments from a competing company