Incidence of Nd:YAG capsulotomy following single-piece monofocal acrylic IOL implantation: a retrospective real-world evidence study in the UK

Session Details

Session Title: Presented Poster Session: IOL Opacification

Venue: Poster Village: Pod 1

First Author: : M.Dhariwal IRELAND

Co Author(s): :    C. Bouchet   D. O Boyle   J. Khan   A. Venerus   A. Muthutantri           

Abstract Details

Purpose:

Posterior capsular opacification (PCO) following cataract surgery causes visual impairment. Its treatment, Nd:YAG capsulotomy has healthcare resource and cost implications, and is also associated with complications having adverse clinical consequences. Hydrophobic acrylic IOLs including AcrySof IOLs have shown to be associated with a reduced risk of Nd:YAG capsulotomy procedures vs. hydrophilic acrylic IOLs. Evidence by IOL material has been largely generated through controlled, small sample size, short follow-up studies. In this study, we evaluated the real-world incidence of Nd:YAG capsulotomy up to 5 years post-cataract surgery, comparing single-piece monofocal non-toric acrylic IOLs in a large cohort of procedures.

Setting:

This study is a retrospective analysis of anonymized electronic medical records (EMR) of cataract procedures from a sample of 7 UK NHS (National Health Service) ophthalmology clinics. This post-hoc IOL brand specific analysis was an extension to study presented during 2017 ESCRS congress with the same population definition.

Methods:

EMR data relating to cataract procedures in patients (≥65 years) which were implanted with single-piece acrylic monofocal IOLs during 2010-2013 were retrospectively analyzed. Procedures with records of capsular tension ring use during surgery, post-op vitrectomy or PC rupture were excluded. Single-piece acrylic IOL models with >500 implants were considered in the analysis. For each included IOL brand, a 3 and 5 year Nd:YAG capsulotomy incidence proportion with 95% CI were calculated. The level of significance was adjusted using the Bonferroni’s method of adjustment to account for multiplicity.

Results:

Final sample included hydrophobic acrylic AcrySof (n=12,870) and Tecnis (n=15,083) IOLs; hydrophilic acrylic B&L (n=9,344), Lenstec (n=6,274), and Rayner (n=4,183) IOLs. Three years after implantation, Nd:YAG incidence was 2.4% (CI 2.1%-2.6%) for AcrySof, 5.1% (CI 4.8%-5.5%) for Tecnis, 9.2% (CI 8.6%-9.8%) for B&L, 12.3% (CI 11.5%-13.1%) for Lenstec, and 12.6% (CI 11.6%-13.6%) for Rayner IOLs. Z-test statistics showed highly significant (P <0.001) results for AcrySof vs. each comparator IOL brand. Nd:YAG incidence for each IOL brand further increased at 5-years follow-up, however AcrySof IOLs still had significantly lower Nd:YAG capsulotomy incidence vs. comparator IOL brands.

Conclusions:

Our findings indicate that single-piece AcrySof IOLs have significantly lower Nd:YAG capsulotomy incidence post-cataract surgery, compared to single-piece Tecnis, B&L, Lenstec, and Rayner IOLs. The findings remained significantly in favor of AcrySof IOLs after adjusting for confounders. This study highlights the importance of real world evidence to generate robust long-term data on clinically relevant outcomes post-cataract surgery. Further research is needed to investigate the risk factors for PCO and complications of the Nd:YAG capsulotomy procedure.

Financial Disclosure:

None