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Is Nd: YAG capsulotomy incidence influenced by IOL biomaterial? Real-word evidence from Spain at 3 & 5 years after cataract surgery

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First Author: J.Belda SPAIN

Co Author(s):    J. Placeres   J. Elvira   D. O'boyle   X. Puig   C. Perez Vives   M. Zou     

Abstract Details

Purpose:

Posterior Capsule Opacification (PCO) is the most common complication after cataract surgery and can result in reduced visual acuity, impaired contrast sensitivity and glare disability. Nd:YAG laser capsulotomies are performed to treat PCO, and can result in additional burden to patients and health care systems. Published evidence suggests that hydrophobic AcrySof intraocular lenses (IOLs) have a demonstrated lower incidence of Nd:YAG capsulotomy compared to other hydrophobic and hydrophilic IOLs. However, there is a paucity of comparative evidence versus IOLs with a hydrophilic-with-hydrophobic surface. The aim of this research was therefore to generate robust real-world evidence to fill this gap.

Setting:

This study is a retrospective analysis of anonymised electronic medical records of cataract patients from two large Spanish University hospitals of the Ribera Salud group in the Torrevieja-Vinalopó healthcare area who are main providers of ophthalmic procedures in the Alicante region.

Methods:

De-identified electronic healthcare records for patients aged 65+ years who underwent cataract surgery during the period Jan 2007 – Dec 2017 were extracted from the two large Spanish regional hospitals, and analysed with SAS 9.4. Nd:YAG laser capsulotomy incidence proportions and 95% confidence intervals (CI) were reported for hydrophobic acrylic AcrySof IOLs and non-AcrySof IOLs (hydrophilic-with-hydrophobic surface Zeiss Asphina IOLs; hydrophilic acrylic AJL, IOL Tech, and Medicontur IOLs ) at 3 years (n=8,478) and 5 years (n=4,011).

Results:

At 3 and 5 years post-surgery, Nd:YAG incidence was significantly lower for AcrySof compared to the other models. At 3-years the incidence of Nd:YAG capsulotomy for each IOL studied was as follows: 5.0% (CI 3.9%-6.1%) for AcrySof, 21.2% (CI 19.9%-22.5%) for Zeiss Asphina, 23.1% (CI 21.0%-25.2%) for Medicontur IOLs, 23.2% (CI 14.7%-31.6%) for IOL Tech, and 31.1% (CI 28.6%-33.5%) for the AJL IOL. While at 5-years, the following Nd:YAG rates were observed: 8.8% (CI 6.0 %-11.6%) for AcrySof, 44.3% (CI 42.4 %-46.2%) for Zeiss Asphina, 44.0% (CI 33.4 %-54.7%) for IOL Tech and 47.4% (CI 44.1 %-50.6%) for AJL.

Conclusions:

This study generated robust real-world evidence on the relationship between IOL biomaterial and the incidence of Nd:YAG capsulotomy to treat PCO. The results indicate AcrySof single-piece IOLs are protective against PCO and therefore reduce the requirement for Nd:YAG treatment compared to other single-piece hydrophilic-with-hydrophobic surface and hydrophilic acrylic IOLs 3 years after cataract surgery. For each comparison, the protective effect of AcrySof IOLs with respect to PCO development became more pronounced when the follow-up period was extended to 5 years. Future research may be warranted to investigate consequence of lens choice for patient quality of life and overall healthcare costs.

Financial Disclosure:

... is employed by a for-profit company with an interest in the subject of the presentation