Comparison of posterior capsule opacification between the 1-piece and 3-piece Acrysof intraocular lenses: two-year results of a randomized trial

Ophthalmology. 2004 Oct;111(10):1840-6. doi: 10.1016/j.ophtha.2004.03.028.


Purpose: To compare intensity of posterior capsule opacification (PCO) between the 1-piece and 3-piece haptic designs of an open-loop hydrophobic acrylic intraocular lens (IOL).

Design: A randomized, patient- and examiner-masked clinical trial with intraindividual comparison.

Participants: Fifty-two patients with bilateral age-related cataract (104 eyes).

Methods: Each patient had cataract surgery in both eyes and received a 1-piece Acrysof IOL in one eye and a 3-piece Acrysof IOL in the fellow eye. Follow-up examinations were at 1 week, 1 month, 6 months, 1 year, and 2 years. Patients were examined at the slit lamp, visual acuity (VA) was determined, and standardized high-resolution digital retroillumination images of the posterior capsule were taken. The intensity of PCO was assessed subjectively at the slit lamp and objectively using automated image analysis software.

Main outcome measure: Posterior capsule opacification score (scale, 0-10).

Results: There was no significant difference between IOL styles in best-corrected VA, rhexis/IOL overlap, capsular folds, and amount of anterior capsule opacification during the follow-up period. One year postoperatively, the amount of regeneratory PCO was higher for the 1-piece Acrysof eyes (image analysis software score: 1.3) than for the 3-piece Acrysof eyes (score: 0.9; P = 0.002). However, 2 years postoperatively, there was no significant difference between the 2 IOL styles (1-piece: 1.5; 3-piece: 1.3; P = 0.3). Neodymium:yttrium-aluminum-garnet capsulotomy was not performed in the study.

Conclusion: One year postoperatively, the 1-piece Acrysof showed slightly more regeneratory PCO than the 3-piece Acrysof. However, 2 years postoperatively, the barrier effect of the 1-piece design was comparable to that of the 3-piece haptic design, with low PCO intensity.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Acrylic Resins / adverse effects*
  • Aged
  • Cataract / etiology*
  • Humans
  • Lens Capsule, Crystalline / pathology*
  • Lens Implantation, Intraocular
  • Lenses, Intraocular / adverse effects*
  • Phacoemulsification*
  • Postoperative Complications*
  • Prosthesis Design
  • Visual Acuity


  • Acrylic Resins